Provider Demographics
NPI:1083686927
Name:LAMB, CHARLES WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:LAMB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CHESTNUT ST
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1160
Mailing Address - Country:US
Mailing Address - Phone:607-547-5230
Mailing Address - Fax:607-547-5578
Practice Address - Street 1:71 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1160
Practice Address - Country:US
Practice Address - Phone:607-547-5230
Practice Address - Fax:607-547-5578
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-04
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003704-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6802870OtherGHI
NY206520OtherUNITED BEHAVIORAL HEALTH
NY418552OtherVALUE OPTIONS
NY6896551OtherCDPHP/VALUE OPTIONS
NY7460OtherUNIVERA HEALTHCARE
NY01151371Medicaid
NY6896551OtherVALUE OPTIONS
NY6802870OtherGHI