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General NPI Number Information
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NPI Number | 1770960239
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Entity Type | Individual
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Provider Name | DEIDRA O'LOUGHLIN M.A.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 2090 ADAM CLAYTON POWELL JR BLVD
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City | NEW YORK
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State | NY
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Zip | 10027-4990
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Country | US
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Telephone | 718-772-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 33-00 NORTHERN BLVD
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-2215
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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