Healthcare Provider Details

I. General information

NPI: 1952608564
Provider Name (Legal Business Name): AMY BENTLEY LAMBORN M.DIV., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 W 9TH ST #7A
NEW YORK NY
10011-8971
US

IV. Provider business mailing address

5030 HENRY HUDSON PKWY E
BRONX NY
10471-3216
US

V. Phone/Fax

Practice location:
  • Phone: 917-557-0532
  • Fax:
Mailing address:
  • Phone: 718-548-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: