Provider Demographics
NPI:1205865284
Name:LEMLE, RUSSELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:LEMLE
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 1:440 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-5081
Mailing Address - Country:US
Mailing Address - Phone:415-981-4234
Mailing Address - Fax:415-381-5489
Practice Address - Street 1:101 THE EMBARCADERO
Practice Address - Street 2:STE 213
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105
Practice Address - Country:US
Practice Address - Phone:415-981-4234
Practice Address - Fax:415-381-5489
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist