Provider Demographics
NPI:1497786404
Name:PORCU, LEIDE (PHD LPSA)
Entity Type:Individual
Prefix:
First Name:LEIDE
Middle Name:
Last Name:PORCU
Suffix:
Gender:F
Credentials:PHD LPSA
Other - Prefix:DR
Other - First Name:LEIDE
Other - Middle Name:
Other - Last Name:PORCU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LPSA
Mailing Address - Street 1:303 5TH AVE RM 1309
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6646
Mailing Address - Country:US
Mailing Address - Phone:212-929-7724
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1309
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6646
Practice Address - Country:US
Practice Address - Phone:212-929-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000210-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis