Provider Demographics
NPI:1376673517
Name:SGAMBATI, LYNNE Z (MFT)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:Z
Last Name:SGAMBATI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9255
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-0255
Mailing Address - Country:US
Mailing Address - Phone:510-520-3340
Mailing Address - Fax:510-841-7509
Practice Address - Street 1:1821 CATALINA AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1906
Practice Address - Country:US
Practice Address - Phone:510-520-3340
Practice Address - Fax:510-841-7509
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39453106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist