Provider Demographics
NPI:1467875567
Name:HIMMELBERGER, LYNETTE S (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:S
Last Name:HIMMELBERGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 E CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4359
Mailing Address - Country:US
Mailing Address - Phone:602-867-4827
Mailing Address - Fax:
Practice Address - Street 1:9375 E SHEA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6991
Practice Address - Country:US
Practice Address - Phone:480-252-5152
Practice Address - Fax:480-685-4948
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW110711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical