Provider Demographics
NPI:1851340582
Name:MYERS, LORNA VERONICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:VERONICA
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E 40TH ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1801
Mailing Address - Country:US
Mailing Address - Phone:212-661-7486
Mailing Address - Fax:212-661-7496
Practice Address - Street 1:104 E 40TH ST
Practice Address - Street 2:SUITE 607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-661-7486
Practice Address - Fax:212-661-7496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0148781103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02265130Medicaid
NY02265130Medicaid