Provider Demographics
NPI:1376318923
Name:LOMBA, ALICIA ELIZABETH (MED)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ELIZABETH
Last Name:LOMBA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2620
Mailing Address - Country:US
Mailing Address - Phone:856-904-6868
Mailing Address - Fax:
Practice Address - Street 1:223 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2620
Practice Address - Country:US
Practice Address - Phone:856-904-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00765000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional