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General NPI Number Information
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NPI Number | 1417302167
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Entity Type | Organization
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Legal Business Name | JOHN P LOMBARDO, PHD,LICENSED PSYCHOLOGIST,P.C.
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 64 MAIN ST STE 213
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City | CORTLAND
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State | NY
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Zip | 13045-2656
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Country | US
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Telephone | 607-758-3316
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Fax | 607-758-3317
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Provider Business Mailing Address
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Address Line | 1267 GALLAGHER RD # 5428
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City | CORTLAND
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State | NY
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Zip | 13045-8869
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Country | US
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Telephone | 607-758-3316
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Fax | 607-758-3317
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN P LOMBARDO
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Credential | PHD
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Telephone | 607-758-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 004767-1
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License Number State | NY
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