Provider Demographics
NPI:1912525791
Name:GEORGINA INES LAMPHERE A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:GEORGINA INES LAMPHERE A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:INES
Authorized Official - Last Name:LAMPHERE SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-987-1997
Mailing Address - Street 1:10832 LAUREL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7688
Mailing Address - Country:US
Mailing Address - Phone:909-987-1997
Mailing Address - Fax:909-987-0993
Practice Address - Street 1:10832 LAUREL ST STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7688
Practice Address - Country:US
Practice Address - Phone:909-987-1997
Practice Address - Fax:909-987-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health