Healthcare Provider Details

I. General information

NPI: 1831100601
Provider Name (Legal Business Name): LORETTA LOBBIA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E GENESEE ST STE 208
SYRACUSE NY
13202-3130
US

IV. Provider business mailing address

3928 CLOVERFIELD CIR
LIVERPOOL NY
13090-3104
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-2675
  • Fax: 315-476-2678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8837
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: