Provider Demographics
NPI:1922021260
Name:LOMBARDI, GINA COLBY (MA LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:COLBY
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:MA LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RAFF RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-284-7916
Mailing Address - Fax:
Practice Address - Street 1:995 LINDEN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3448
Practice Address - Country:US
Practice Address - Phone:330-284-7916
Practice Address - Fax:866-651-4469
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007913L103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017834450004Medicaid