Provider Demographics
NPI:1831131945
Name:LAM, JUDY N (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:N
Last Name:LAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0508
Mailing Address - Country:US
Mailing Address - Phone:208-283-0628
Mailing Address - Fax:208-209-2388
Practice Address - Street 1:2409 N 21ST ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0508
Practice Address - Country:US
Practice Address - Phone:208-283-0628
Practice Address - Fax:208-209-2388
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16908103TC0700X
IDPSY 202366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical