Provider Demographics
NPI:1205861663
Name:LIVINGSTON, LOUISA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISA
Middle Name:ROSE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 30TH ST
Mailing Address - Street 2:3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7389
Mailing Address - Country:US
Mailing Address - Phone:212-685-7653
Mailing Address - Fax:
Practice Address - Street 1:127 E 30TH ST
Practice Address - Street 2:3D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7389
Practice Address - Country:US
Practice Address - Phone:212-685-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011243-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV7B741Medicare ID - Type UnspecifiedEMPIRE MEDICARE PROVIDER