Provider Demographics
NPI:1376215046
Name:PROVIDENTE, LAYLA (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:PROVIDENTE
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SENECA ST W
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7420
Mailing Address - Country:US
Mailing Address - Phone:631-742-2237
Mailing Address - Fax:
Practice Address - Street 1:2 SENECA ST W
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7420
Practice Address - Country:US
Practice Address - Phone:631-742-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool