Provider Demographics
NPI:1316432867
Name:RAMBO, LEWIS M (PHD IN PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:M
Last Name:RAMBO
Suffix:
Gender:M
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 SELBY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6614
Mailing Address - Country:US
Mailing Address - Phone:781-354-8882
Mailing Address - Fax:
Practice Address - Street 1:624 SELBY AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6614
Practice Address - Country:US
Practice Address - Phone:781-354-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1732-PY-PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist