Provider Demographics
NPI:1538358536
Name:LOBIANCO, MICHAEL (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOBIANCO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S BROAD ST
Mailing Address - Street 2:SUITE 905
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4121
Mailing Address - Country:US
Mailing Address - Phone:215-408-4462
Mailing Address - Fax:215-408-4463
Practice Address - Street 1:230 S BROAD ST
Practice Address - Street 2:SUITE 905
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4121
Practice Address - Country:US
Practice Address - Phone:215-408-4462
Practice Address - Fax:215-408-4463
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW016139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health