Provider Demographics
NPI:1902317464
Name:LUCIO, LOBELLE MAGSOMBOL (AMFT)
Entity Type:Individual
Prefix:
First Name:LOBELLE
Middle Name:MAGSOMBOL
Last Name:LUCIO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:LOBELLE
Other - Middle Name:SIAPNO
Other - Last Name:MAGSOMBOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:86 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2015
Mailing Address - Country:US
Mailing Address - Phone:408-510-7080
Mailing Address - Fax:
Practice Address - Street 1:86 S 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2015
Practice Address - Country:US
Practice Address - Phone:408-510-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT98415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health