Provider Demographics
NPI:1467658542
Name:LAMBERT, JAY (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9525
Mailing Address - Country:US
Mailing Address - Phone:623-363-3031
Mailing Address - Fax:623-505-2477
Practice Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9525
Practice Address - Country:US
Practice Address - Phone:623-363-3031
Practice Address - Fax:623-505-2477
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW122951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW12295OtherLICENSE