Provider Demographics
NPI:1790978799
Name:LAM, JESSE (MA, PSYD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PSYD
Mailing Address - Street 1:4423 FORTRAN COURT
Mailing Address - Street 2:SUITE 136
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2130
Mailing Address - Country:US
Mailing Address - Phone:408-316-8085
Mailing Address - Fax:
Practice Address - Street 1:2625 ZANKER RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2130
Practice Address - Country:US
Practice Address - Phone:408-316-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health