Provider Demographics
NPI:1285949909
Name:LAMBERT, TINOTHY PATRICK (MA)
Entity type:Individual
Prefix:
First Name:TINOTHY
Middle Name:PATRICK
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12518 W CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-6318
Mailing Address - Country:US
Mailing Address - Phone:623-695-6617
Mailing Address - Fax:
Practice Address - Street 1:17999 W SURPRISE FARMS LOOP S
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-6641
Practice Address - Country:US
Practice Address - Phone:623-876-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool