Provider Demographics
NPI:1902342975
Name:LAMBERT, BRYAN
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CATC
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-1409
Mailing Address - Country:US
Mailing Address - Phone:415-342-7119
Mailing Address - Fax:
Practice Address - Street 1:10 KNOB HILL ROAD
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956-1409
Practice Address - Country:US
Practice Address - Phone:415-342-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL0908121753101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)