Provider Demographics
NPI:1083952451
Name:LOMBARD, TAMARA NEUBAUER (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:NEUBAUER
Last Name:LOMBARD
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1517
Mailing Address - Country:US
Mailing Address - Phone:260-436-7131
Mailing Address - Fax:260-436-5123
Practice Address - Street 1:6201 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1517
Practice Address - Country:US
Practice Address - Phone:260-402-1762
Practice Address - Fax:260-436-5123
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041480A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200249850Medicaid