Provider Demographics
NPI:1154705325
Name:LAMBERTH-WILLIAMS, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:LAMBERTH-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4967 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-3709
Mailing Address - Country:US
Mailing Address - Phone:267-575-8403
Mailing Address - Fax:
Practice Address - Street 1:4967 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-3709
Practice Address - Country:US
Practice Address - Phone:267-575-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001479251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4612644434OtherIRS EMPLOYER IDENTIFICATION NUMBER