Provider Demographics
NPI:1700158763
Name:LEX PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:LEX PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:CAJETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-224-1533
Mailing Address - Street 1:4360 DOUGLASTON PKWY
Mailing Address - Street 2:#221
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1838
Mailing Address - Country:US
Mailing Address - Phone:718-224-1533
Mailing Address - Fax:
Practice Address - Street 1:4360 DOUGLASTON PKWY
Practice Address - Street 2:#221
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1838
Practice Address - Country:US
Practice Address - Phone:718-224-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017458103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty