Healthcare Provider Details

I. General information

NPI: 1588162069
Provider Name (Legal Business Name): LAMB AND MADDUX LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST # 101-1
HACKENSACK NJ
07601-7113
US

IV. Provider business mailing address

90 MAIN ST # 101-1
HACKENSACK NJ
07601-7113
US

V. Phone/Fax

Practice location:
  • Phone: 212-810-6365
  • Fax:
Mailing address:
  • Phone: 212-810-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number35SI00482600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JEMOUR MADDUX
Title or Position: MANAGING DIRECTOR
Credential: PSY.D., ABPP
Phone: 212-810-6365