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General NPI Number Information
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NPI Number | 1336209576
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Entity Type | Organization
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Legal Business Name | MARYDINE L LAMB PA
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 2328 MANATEE AVE WEST
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City | BRADENTON
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State | FL
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Zip | 34205
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Country | US
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Telephone | 941-684-1622
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Fax | 941-747-1093
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Provider Business Mailing Address
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Address Line | PO BOX 2653
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City | BRANDON
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State | FL
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Zip | 33509-2653
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Country | US
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Telephone | 941-684-1622
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Fax | 941-747-1093
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Authorized Official
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Title or Position | PRESIDENT OF PA
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Name | MRS. MARYDINE LENTZ LAMB
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Credential | MSW LCSW
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Telephone | 813-230-2257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW2375
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License Number State | FL
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