Provider Demographics
NPI:1457182032
Name:LOMBARD, MICHAELA ROSE
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ROSE
Last Name:LOMBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E ASBURY ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4046
Mailing Address - Country:US
Mailing Address - Phone:908-892-0743
Mailing Address - Fax:
Practice Address - Street 1:21 E ASBURY ANDERSON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4046
Practice Address - Country:US
Practice Address - Phone:908-892-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13473036-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health