| Georgina Ines Lamphere A Professional Psychology Corporation | |
|
10832 Laurel St Ste 102 Rancho Cucamonga CA 91730-7688 | |
| (909) 987-1997 | |
| (909) 987-0993 |
| Full Name | Georgina Ines Lamphere A Professional Psychology Corporation |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10832 Laurel St Ste 102, Rancho Cucamonga, California |
| Authorized Official Name and Position | Georgina Ines Lamphere Sullivan (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9099871997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Georgina Ines Lamphere A Professional Psychology Corporation 10832 Laurel St Ste 102 Rancho Cucamonga CA 91730-7688 Ph: (909) 987-1997 | Georgina Ines Lamphere A Professional Psychology Corporation 10832 Laurel St Ste 102 Rancho Cucamonga CA 91730-7688 Ph: (909) 987-1997 |
| NPI Number | 1912525791 |
|---|---|
| Provider Enumeration Date | 07/08/2020 |
| Last Update Date | 07/08/2020 |
| Certification Date | 07/08/2020 |
| Medicare PECOS PAC ID | 4789091687 |
|---|---|
| Medicare Enrollment ID | O20210319001705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912525791 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Georgina I Lamphere |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487633616 PECOS PAC ID: 0345270062 Enrollment ID: I20050812000614 |
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