Provider Demographics
NPI:1114024171
Name:OCHOA, LOURDES LAURA (PHD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:LAURA
Last Name:OCHOA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:90 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1931
Mailing Address - Country:US
Mailing Address - Phone:914-591-7266
Mailing Address - Fax:
Practice Address - Street 1:156 W 56TH ST STE 1804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-851-8100
Practice Address - Fax:888-977-2547
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical