Healthcare Provider Details

I. General information

NPI: 1801091871
Provider Name (Legal Business Name): ALAN THOMAS LAMB LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FREEDOM BLVD
WATSONVILLE CA
95076-2780
US

IV. Provider business mailing address

1430 FREEDOM BLVD
WATSONVILLE CA
95076-2780
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8200
  • Fax: 831-454-4663
Mailing address:
  • Phone: 831-763-8200
  • Fax: 831-454-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 13369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: