Provider Demographics
NPI:1548784721
Name:LUMUMBA, IMANI Y (CLINICIAN)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:Y
Last Name:LUMUMBA
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-1512
Mailing Address - Country:US
Mailing Address - Phone:610-704-5702
Mailing Address - Fax:215-754-0318
Practice Address - Street 1:1315 WINDRIM AVENUE
Practice Address - Street 2:2ND FL. AOP6C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:215-456-2603
Practice Address - Fax:215-754-0318
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health