=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376925065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAMBERTON PSYCHIATRY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2015
-----------------------------------------------------
Last Update Date | 06/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2025 N SUMMIT AVE SUITE 107
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-395-1777
-----------------------------------------------------
Fax | 414-395-8840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2025 N SUMMIT AVE SUITE 107
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-395-1777
-----------------------------------------------------
Fax | 414-395-8840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. LEANDREA SUE LAMBERTON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 414-395-1777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 40574
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------