Provider Demographics
NPI:1710348172
Name:PALOMBI, LORI LYNN (MA AMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:PALOMBI
Suffix:
Gender:F
Credentials:MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W LA VETA AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4448
Mailing Address - Country:US
Mailing Address - Phone:714-532-9295
Mailing Address - Fax:714-532-9291
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4402
Practice Address - Country:US
Practice Address - Phone:714-532-9295
Practice Address - Fax:714-532-9291
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XOtherMEDICARE