Provider Demographics
NPI:1598420598
Name:BOMBA, ALISON JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:JEAN
Last Name:BOMBA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:JEAN
Other - Last Name:DUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:15 N COURT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5413
Mailing Address - Country:US
Mailing Address - Phone:240-405-9661
Mailing Address - Fax:301-732-4459
Practice Address - Street 1:15 N COURT ST STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5413
Practice Address - Country:US
Practice Address - Phone:240-405-9661
Practice Address - Fax:301-732-4459
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical