Healthcare Provider Details

I. General information

NPI: 1629192570
Provider Name (Legal Business Name): THEODORE ALBERT LOMBARDO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 SAN JOSE PL ONE SAN JOSE COMPLEX, SUITE 35
JACKSONVILLE FL
32257-8858
US

IV. Provider business mailing address

3750 SAN JOSE PL ONE SAN JOSE COMPLEX, SUITE 35
JACKSONVILLE FL
32257-8858
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-9006
  • Fax: 904-886-4060
Mailing address:
  • Phone: 904-886-9006
  • Fax: 904-886-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5167
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5167
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY5167
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5167
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPY5167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: