Provider Demographics
NPI:1902204597
Name:DBA NANCY FREITAS LAMBERT PSYD
Entity Type:Organization
Organization Name:DBA NANCY FREITAS LAMBERT PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAS LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-460-1330
Mailing Address - Street 1:1330 LINCOLN AVE STE 102B
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2141
Mailing Address - Country:US
Mailing Address - Phone:415-460-1330
Mailing Address - Fax:
Practice Address - Street 1:1330 LINCOLN AVE STE 102B
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2141
Practice Address - Country:US
Practice Address - Phone:415-460-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23070251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health