Healthcare Provider Details

I. General information

NPI: 1366981011
Provider Name (Legal Business Name): BARBARA JOAN LOMBARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9308 PAUL ADRIAN DR
SAINT LOUIS MO
63126-2608
US

IV. Provider business mailing address

9308 PAUL ADRIAN DR
SAINT LOUIS MO
63126-2608
US

V. Phone/Fax

Practice location:
  • Phone: 314-609-5031
  • Fax:
Mailing address:
  • Phone: 314-609-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0403928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: