Provider Demographics
NPI:1962595553
Name:GOMBIN, LORIE
Entity type:Individual
Prefix:MS
First Name:LORIE
Middle Name:
Last Name:GOMBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORIE
Other - Middle Name:JUNE
Other - Last Name:GOMBIN-SPERLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3 IRIS COURT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4302
Mailing Address - Country:US
Mailing Address - Phone:908-337-4073
Mailing Address - Fax:908-756-3694
Practice Address - Street 1:3 IRIS COURT
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-4302
Practice Address - Country:US
Practice Address - Phone:908-337-4073
Practice Address - Fax:908-756-3694
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014343001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical