Provider Demographics
NPI:1316153125
Name:LABOMBAND, KATHY JEAN (LSW MED)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JEAN
Last Name:LABOMBAND
Suffix:
Gender:F
Credentials:LSW MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LONGFELLOW RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-534-0007
Mailing Address - Fax:
Practice Address - Street 1:227 MILL STREET
Practice Address - Street 2:SISTERS OF PROVIDENCE BEHAVIORAL HEALTH METHADONE
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-747-9071
Practice Address - Fax:413-747-9075
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3015935SW101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor