Healthcare Provider Details

I. General information

NPI: 1497786404
Provider Name (Legal Business Name): LEIDE PORCU PHD LPSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEIDE PORCU PHD LPSA

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 5TH AVE RM 1309
NEW YORK NY
10016-6646
US

IV. Provider business mailing address

303 5TH AVE RM 1309
NEW YORK NY
10016-6646
US

V. Phone/Fax

Practice location:
  • Phone: 212-929-7724
  • Fax:
Mailing address:
  • Phone: 212-929-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000210-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: