Provider Demographics
NPI:1376506014
Name:BOMBARA, PAUL EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:BOMBARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORTHGATE CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1957
Mailing Address - Country:US
Mailing Address - Phone:781-860-0922
Mailing Address - Fax:978-851-1027
Practice Address - Street 1:809 MASSACHUSETTS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3918
Practice Address - Country:US
Practice Address - Phone:781-860-0600
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4574101YM0800X
MA582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist