Provider Demographics
NPI:1710162888
Name:RAYMOND W LEMBERG PHD PC
Entity Type:Organization
Organization Name:RAYMOND W LEMBERG PHD PC
Other - Org Name:PSYCHOLOGICAL PAHTWAYS
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 1:2414 W OLD PAINT TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6608
Mailing Address - Country:US
Mailing Address - Phone:928-776-7885
Mailing Address - Fax:928-445-0914
Practice Address - Street 1:20325 N 51ST AVE STE 168
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4624
Practice Address - Country:US
Practice Address - Phone:844-385-3747
Practice Address - Fax:480-462-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AZ658103T00000X
AZ06431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty