Provider Demographics
NPI:1306194881
Name:LALOUCH, MERAV (MA)
Entity Type:Individual
Prefix:MRS
First Name:MERAV
Middle Name:
Last Name:LALOUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5013
Mailing Address - Country:US
Mailing Address - Phone:845-269-5316
Mailing Address - Fax:
Practice Address - Street 1:25 KEITH DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-5013
Practice Address - Country:US
Practice Address - Phone:845-269-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686777328171M00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103T00000XBehavioral Health & Social Service ProvidersPsychologist