Provider Demographics
NPI:1538459110
Name:LAM, JONATHAN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
Last Name:LAM
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 1:4545 CONNECTICUT AVE NW STE 309
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-6016
Mailing Address - Country:US
Mailing Address - Phone:301-802-0074
Mailing Address - Fax:301-652-4061
Practice Address - Street 1:4545 CONNECTICUT AVE NW STE 309
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6016
Practice Address - Country:US
Practice Address - Phone:301-802-0074
Practice Address - Fax:301-652-4061
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000130103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent