Provider Demographics
NPI:1538346879
Name:LOMBARDO-BENJAMIN, HETHER L (LMFT)
Entity type:Individual
Prefix:
First Name:HETHER
Middle Name:L
Last Name:LOMBARDO-BENJAMIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 EXCHANGE STE 250
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1376
Mailing Address - Country:US
Mailing Address - Phone:949-250-0488
Mailing Address - Fax:714-540-1908
Practice Address - Street 1:16580 HARBOR BLVD STE M
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1385
Practice Address - Country:US
Practice Address - Phone:714-975-5201
Practice Address - Fax:714-659-6379
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41782106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 41782OtherBOARD OF BEHAVIORAL SCIEN