Provider Demographics
NPI:1629192570
Name:LOMBARDO, THEODORE ALBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ALBERT
Last Name:LOMBARDO
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 1:3750 SAN JOSE PL
Mailing Address - Street 2:ONE SAN JOSE COMPLEX, SUITE 35
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8858
Mailing Address - Country:US
Mailing Address - Phone:904-886-9006
Mailing Address - Fax:904-886-4060
Practice Address - Street 1:3750 SAN JOSE PL
Practice Address - Street 2:ONE SAN JOSE COMPLEX, SUITE 35
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8858
Practice Address - Country:US
Practice Address - Phone:904-886-9006
Practice Address - Fax:904-886-4060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5167103T00000X, 103TC0700X, 103TC2200X, 103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool