Provider Demographics
NPI:1063847689
Name:DR. MARCIA G LAMM, PHD,LICENSED CLINICAL PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:DR. MARCIA G LAMM, PHD,LICENSED CLINICAL PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:GINGER
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-340-1210
Mailing Address - Street 1:21031 VENTURA BLVD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2203
Mailing Address - Country:US
Mailing Address - Phone:818-340-1210
Mailing Address - Fax:818-340-1207
Practice Address - Street 1:21031 VENTURA BLVD
Practice Address - Street 2:SUITE 507
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2203
Practice Address - Country:US
Practice Address - Phone:818-340-1210
Practice Address - Fax:818-340-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9825305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service