Individual
DR. KENNETH CHRISTOPHER LAZZARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
9160 FORUM CORPORATE PKWY STE 350, FORT MYERS, FL 33905-7808
(239) 391-7313
Mailing address
9160 FORUM CORPORATE PKWY STE 350, FORT MYERS, FL 33905-7808
(239) 391-7313
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301010699
MI
103T00000X
Psychologist
Primary
PY11760
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680F333500
BLUE CROSS BLUE SHIELD
MI
Enumeration date
12/20/2008
Last updated
03/07/2023
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