Provider Demographics
NPI:1356018790
Name:ERNESTO LIRA DE LA ROSA LICENSED PSYCHOLOGIST PLLC
Entity Type:Organization
Organization Name:ERNESTO LIRA DE LA ROSA LICENSED PSYCHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:NOAM
Authorized Official - Last Name:LIRA DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-652-1148
Mailing Address - Street 1:68 BRADHURST AVE APT 8G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE FL 12A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5893
Practice Address - Country:US
Practice Address - Phone:347-652-1148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty