Basic Information
| Provider Information | |||||||||
| NPI: | 1114024171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OCHOA | ||||||||
| FirstName: | LOURDES | ||||||||
| MiddleName: | LAURA | ||||||||
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| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | OCHOA | ||||||||
| OtherFirstName: | LAURA | ||||||||
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| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 90 SYCAMORE LN | ||||||||
| Address2: | |||||||||
| City: | IRVINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105331931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145917266 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 156 W 56TH ST STE 1804 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518100 | ||||||||
| FaxNumber: | 8889772547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 010497 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.