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General NPI Number Information
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NPI Number | 1699050427
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Entity Type | Individual
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Provider Name | LEAH M LAGOS PSY.D, B.C.B
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Gender | Female
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 635 MADISON AVE THIRD FLOOR
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City | NEW YORK
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State | NY
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Zip | 10022-1009
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Country | US
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Telephone | 646-770-1702
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Fax |
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Provider Business Mailing Address
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Address Line | 610 W 42ND ST APARTMENT 48G
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City | NEW YORK
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State | NY
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Zip | 10036-1956
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Country | US
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Telephone | 646-770-1702
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 019086
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License Number State | NY
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