Provider Demographics
NPI:1053564039
Name:LOMBARDO, MARY ANN THERESA (MA;CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MARY ANN
Middle Name:THERESA
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:MA;CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 CARHART CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1865
Mailing Address - Country:US
Mailing Address - Phone:917-670-7862
Mailing Address - Fax:
Practice Address - Street 1:394 CARHART CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1865
Practice Address - Country:US
Practice Address - Phone:917-670-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist