Provider Demographics
NPI:1558974717
Name:LAMBERT, KEVIN T
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4123
Mailing Address - Country:US
Mailing Address - Phone:209-229-4559
Mailing Address - Fax:
Practice Address - Street 1:42 W 8TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4123
Practice Address - Country:US
Practice Address - Phone:209-229-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty