Healthcare Provider Details

I. General information

NPI: 1558885681
Provider Name (Legal Business Name): RAINA V. LAMADE, PH.D. PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 12/04/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BARSTOW RD STE 304
GREAT NECK NY
11021-2209
US

IV. Provider business mailing address

16417 45TH AVE
FLUSHING NY
11358-3215
US

V. Phone/Fax

Practice location:
  • Phone: 631-748-7687
  • Fax:
Mailing address:
  • Phone: 631-748-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RAINA V LAMADE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 631-748-7687