Provider Demographics
NPI:1093177693
Name:MICHAEL LEMBARIS, PSY.D., PSYCHOLOGIST, INC.
Entity Type:Organization
Organization Name:MICHAEL LEMBARIS, PSY.D., PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEMBARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-887-4068
Mailing Address - Street 1:5405 MOREHOUSE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4722
Mailing Address - Country:US
Mailing Address - Phone:619-887-4068
Mailing Address - Fax:866-687-9706
Practice Address - Street 1:5405 MOREHOUSE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4722
Practice Address - Country:US
Practice Address - Phone:619-887-4068
Practice Address - Fax:866-687-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty