Healthcare Provider Details

I. General information

NPI: 1467638148
Provider Name (Legal Business Name): RAYMOND W. LEMBERG,PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2008
Last Update Date: 01/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 VALLEY ST
PRESCOTT AZ
86305-1826
US

IV. Provider business mailing address

812 VALLEY ST
PRESCOTT AZ
86305-1826
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-7885
  • Fax: 928-445-0914
Mailing address:
  • Phone: 928-776-7885
  • Fax: 928-445-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number658
License Number StateAZ

VIII. Authorized Official

Name: DR. RAYMOND WALTER LEMBERG
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 928-776-7885