Provider Demographics
NPI:1366441198
Name:HARRIS-BOSCAINO, LYNDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:HARRIS-BOSCAINO
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 1:24 MALLORY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3118
Mailing Address - Country:US
Mailing Address - Phone:845-352-7164
Mailing Address - Fax:845-352-7164
Practice Address - Street 1:24 MALLORY RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3118
Practice Address - Country:US
Practice Address - Phone:845-352-7164
Practice Address - Fax:845-352-7164
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01426237Medicaid
V4A051Medicare UPIN
NYV4A051Medicare ID - Type Unspecified