Provider Demographics
NPI:1467638148
Name:RAYMOND W. LEMBERG,PH.D., P.C.
Entity Type:Organization
Organization Name:RAYMOND W. LEMBERG,PH.D., P.C.
Other - Org Name:PSYCHOLOGICAL PATHWAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LEMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:928-776-7885
Mailing Address - Street 1:812 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1826
Mailing Address - Country:US
Mailing Address - Phone:928-776-7885
Mailing Address - Fax:928-445-0914
Practice Address - Street 1:812 VALLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1826
Practice Address - Country:US
Practice Address - Phone:928-776-7885
Practice Address - Fax:928-445-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-13
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105642Medicare UPIN
AZZ105641Medicare UPIN
AZZ105640Medicare UPIN