Provider Demographics
NPI:1952437410
Name:ENGLEMAN-LAMPE, CRYSTAL (MFT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:ENGLEMAN-LAMPE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 CAMINITO EMPRESA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7151
Mailing Address - Country:US
Mailing Address - Phone:858-456-1075
Mailing Address - Fax:
Practice Address - Street 1:5827 CAMINITO EMPRESA
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7151
Practice Address - Country:US
Practice Address - Phone:858-456-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM.F.T. 22170OtherLICENSE NUMBER
CAMFT22170OtherSTATE LICENSE