Provider Demographics
NPI:1902411838
Name:TAYAS, LOURDES V
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:V
Last Name:TAYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 CLYDE ST APT 7J
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4014
Mailing Address - Country:US
Mailing Address - Phone:917-600-8256
Mailing Address - Fax:
Practice Address - Street 1:6725 CLYDE ST APT 7J
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4014
Practice Address - Country:US
Practice Address - Phone:917-600-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)