Provider Demographics
NPI:1962416446
Name:FRIEDMAN-LOMBARDO, JACLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:FRIEDMAN-LOMBARDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1704
Mailing Address - Country:US
Mailing Address - Phone:973-783-4628
Mailing Address - Fax:973-746-1176
Practice Address - Street 1:72 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2021
Practice Address - Country:US
Practice Address - Phone:973-746-1176
Practice Address - Fax:973-746-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3930103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist