Healthcare Provider Details

I. General information

NPI: 1942127121
Provider Name (Legal Business Name): LOURDES SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 TRUXTON RD
DIX HILLS NY
11746-6710
US

IV. Provider business mailing address

19 TRUXTON RD
DIX HILLS NY
11746-6710
US

V. Phone/Fax

Practice location:
  • Phone: 917-510-5624
  • Fax:
Mailing address:
  • Phone: 917-510-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: