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General NPI Number Information
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NPI Number | 1194771683
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Entity Type | Individual
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Provider Name | LOURIVAL BAPTISTA NETO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 3959 BROADWAY 619 NORTH
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City | NEW YORK
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State | NY
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Zip | 10032-1559
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Country | US
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Telephone | 212-305-7879
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Fax | 212-305-6614
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Provider Business Mailing Address
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Address Line | 1051 RIVERSIDE DR STE 6004
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City | NEW YORK
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State | NY
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Zip | 10032-1007
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Country | US
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Telephone | 646-774-5365
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Fax | 646-774-5359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 212802
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 250963
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License Number State | NY
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