Provider Demographics
NPI:1922326453
Name:LOMBARDI, IDA-JEAN
Entity Type:Individual
Prefix:MS
First Name:IDA-JEAN
Middle Name:
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHURCH ST
Mailing Address - Street 2:NYACK CONSULTATION CENTER
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3108
Mailing Address - Country:US
Mailing Address - Phone:845-358-1677
Mailing Address - Fax:845-358-3640
Practice Address - Street 1:140 OLD ORANGEBURG ROAD
Practice Address - Street 2:ROCKLAND PSYCHIATRIC CENTER
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:845-359-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73036174104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker