Provider Demographics
NPI:1306110275
Name:LAMB, LAWRENCE ALBERT (LMHC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALBERT
Last Name:LAMB
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7450
Mailing Address - Country:US
Mailing Address - Phone:954-358-1481
Mailing Address - Fax:954-358-1483
Practice Address - Street 1:610 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7450
Practice Address - Country:US
Practice Address - Phone:954-358-1481
Practice Address - Fax:954-358-1483
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5177101YM0800X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst