Basic Information
| Provider Information | |||||||||
| NPI: | 1801091871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMB | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 FREEDOM BLVD | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950762780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317638200 | ||||||||
| FaxNumber: | 8314544663 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 FREEDOM BLVD | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950762780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317638200 | ||||||||
| FaxNumber: | 8314544663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 13369 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | LCS13369 | 01 | CA | PROFESSIONAL LICENSE# | OTHER | ZZZ91891Z | 01 | CA | MEDICARE GROUP PTAN# | OTHER | ZZZ92069Z | 01 | CA | MEDICARE GROUP PTAN# | OTHER | ZZZ91892Z | 01 | CA | MEDICARE GROUP PTAN# | OTHER |