Provider Demographics
NPI:1871707901
Name:BOMBARDIERI, MERLE (MSW)
Entity type:Individual
Prefix:
First Name:MERLE
Middle Name:
Last Name:BOMBARDIERI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEDFORD ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4319
Mailing Address - Country:US
Mailing Address - Phone:781-862-1662
Mailing Address - Fax:781-862-1164
Practice Address - Street 1:33 BEDFORD ST
Practice Address - Street 2:SUITE 18
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4319
Practice Address - Country:US
Practice Address - Phone:781-862-1662
Practice Address - Fax:781-862-1164
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABCBS OF MASSACHUSETTOtherP02847