Healthcare Provider Details

I. General information

NPI: 1851037071
Provider Name (Legal Business Name): JANELLE LAMB LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 LOBO CANYON ROAD
GRANTS NM
87020
US

IV. Provider business mailing address

1593 SPRING HILL RD STE 600
VIENNA VA
22182-2252
US

V. Phone/Fax

Practice location:
  • Phone: 505-876-8326
  • Fax:
Mailing address:
  • Phone: 703-749-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-10173
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: