Provider Demographics
NPI:1366107641
Name:LEMBERGER, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LEMBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 HARKER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2164
Mailing Address - Country:US
Mailing Address - Phone:562-528-1735
Mailing Address - Fax:
Practice Address - Street 1:565 HARKER ST APT 4
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2164
Practice Address - Country:US
Practice Address - Phone:562-528-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86648101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health