Provider Demographics
NPI:1891153953
Name:LOMAS, ROBERT I
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LOMAS
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:KIETH
Other - Last Name:LOMAS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LICENSE CHEMICAL DE
Mailing Address - Street 1:418 BIRCH STREET
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567
Mailing Address - Country:US
Mailing Address - Phone:419-330-4102
Mailing Address - Fax:
Practice Address - Street 1:418 BIRCH ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1409
Practice Address - Country:US
Practice Address - Phone:419-330-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141666101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)