Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-02-0857 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 0161410 | NY |
Y | 103TC0700X | Clinical Psychologist | 0161410 | NY |
NPI | 1053620120 |
---|---|
Provider Name | Dr. Latha V Soorya |
First Address | New York, NY 10029-6508 |
Second Address | New York, NY 10029-6508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 06/10/2010 |