Provider Demographics
NPI:1053702928
Name:LAMBROS, SAMANTHA ASHLEIGH (MED, BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ASHLEIGH
Last Name:LAMBROS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ASHLEIGH
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19820 N 13TH AVE UNIT 255
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4317
Mailing Address - Country:US
Mailing Address - Phone:602-487-1879
Mailing Address - Fax:
Practice Address - Street 1:801 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3660
Practice Address - Country:US
Practice Address - Phone:602-535-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-14-16895103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26-475-3045OtherWORKPLACE