Provider Demographics
NPI:1285094177
Name:IUCHA, CORNELIA (PHD)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:IUCHA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 RAYMOND STREET ORLANDO VA MEDICAL CENTER
Mailing Address - Street 2:LAKE BALDWIN OPC MENTAL HEALTH, ROOM 422
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-646-5500
Mailing Address - Fax:407-513-9328
Practice Address - Street 1:2501 RAYMOND STREET ORLANDO VA MEDICAL CENTER
Practice Address - Street 2:LAKE BALDWIN OPC MENTAL HEALTH, ROOM 422
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-646-5500
Practice Address - Fax:407-513-9328
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005492103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist