MEDICARE: LAURA IOCIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	019082	NY

General Provider Information

NPI Number	:	1578939401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA IOCIN PH.D.

Provider Business Mailing Address
First Line	:	160 CONVENT AVE
Second Line	:	MARSHAK SCIENCE BUILDING J-15, COUNSELING CENTER
City	:	NEW YORK
State	:	NY
Zip	:	10031-9101
Country	:	US
Telephone Number	:	347-665-8634
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 CONVENT AVE
Second Line	:	MARSHAK SCIENCE BUILDING J-15, COUNSELING CENTER
City	:	NEW YORK
State	:	NY
Zip	:	10031-9101
Country	:	US
Telephone Number	:	347-665-8634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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