Provider Demographics
NPI:1578930483
Name:LOMBARDI, MICHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARINE AIRCRAFT GROUP 14, USMC FORCES ATLANTIC
Mailing Address - Street 2:POSTAL SERVICE CENTER BOX 8051
Mailing Address - City:CHERRY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28533
Mailing Address - Country:US
Mailing Address - Phone:252-466-5100
Mailing Address - Fax:
Practice Address - Street 1:MARINE AIRCRAFT GROUP 14, USMC FORCES ATLANTIC
Practice Address - Street 2:BLDG 200
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:252-466-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007293103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical