Provider Demographics
NPI:1003021346
Name:LAMBERT, GLEN RAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:RAY
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 REBECCA CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5864
Mailing Address - Country:US
Mailing Address - Phone:801-272-7742
Mailing Address - Fax:801-322-2831
Practice Address - Street 1:1361 REBECCA CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5864
Practice Address - Country:US
Practice Address - Phone:801-272-7742
Practice Address - Fax:801-322-2831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109658-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical