Healthcare Provider Details

I. General information

NPI: 1376506014
Provider Name (Legal Business Name): PAUL EUGENE BOMBARA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MASSACHUSETTS AVE 2ND FLOOR
LEXINGTON MA
02420-3918
US

IV. Provider business mailing address

2 NORTHGATE CIR
LEXINGTON MA
02420-1957
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-0600
  • Fax: --
Mailing address:
  • Phone: 781-860-0922
  • Fax: 978-851-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4574
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number582
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: