Provider Demographics
NPI:1447475504
Name:LAZCANO, REBECA (LMHC)
Entity type:Individual
Prefix:MS
First Name:REBECA
Middle Name:
Last Name:LAZCANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 NW 12TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1840
Mailing Address - Country:US
Mailing Address - Phone:305-923-2795
Mailing Address - Fax:
Practice Address - Street 1:8323 NW 12TH ST STE 206
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1840
Practice Address - Country:US
Practice Address - Phone:305-923-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21700101YM0800X, 103K00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker