Individual
DR. JERRY M LAZAROFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1029 N PROVIDENCE RD, MEDIA, PA 19063-1404
(610) 566-6633
(610) 566-6637
Mailing address
1029 N PROVIDENCE RD, MEDIA, PA 19063-1404
(610) 566-6633
(610) 566-6637
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS-002867-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA1155
PA BLUE SHIELD
—
Enumeration date
01/19/2006
Last updated
07/08/2007
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