Provider Demographics
NPI:1013553726
Name:LOMIS, PAULINE ATHENA
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ATHENA
Last Name:LOMIS
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 1:2404 28TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1904
Mailing Address - Country:US
Mailing Address - Phone:347-418-1409
Mailing Address - Fax:
Practice Address - Street 1:2404 28TH ST # 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1904
Practice Address - Country:US
Practice Address - Phone:347-418-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst