Basic Information
Provider Information | |||||||||
NPI: | 1578954939 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAMBERT | ||||||||
FirstName: | TANESHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAMBERT | ||||||||
OtherFirstName: | TANESHA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LCSW | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 200 RETREAT AVENUE | ||||||||
Address2: | HARTFORD HOSPITAL PSYCHIATRY DEPT | ||||||||
City: | HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061063309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8605457200 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 RETREAT AVENUE | ||||||||
Address2: | HARTFORD HOSPITAL PSYCHIATRY DEPT | ||||||||
City: | HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 06106 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8605457200 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2015 | ||||||||
LastUpdateDate: | 06/04/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 000764 | CT | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | 009866 | CT | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 009866 | 01 | CT | DEPARTMENT OF PUBLIC HEALTH | OTHER |