Provider Demographics
NPI:1598167769
Name:BOMBARD, ALLISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BOMBARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LYDALE PL
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6125
Mailing Address - Country:US
Mailing Address - Phone:203-514-4189
Mailing Address - Fax:
Practice Address - Street 1:605 WASHINGTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1123
Practice Address - Country:US
Practice Address - Phone:203-514-4189
Practice Address - Fax:203-442-4964
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT90821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker