Provider Demographics
NPI:1285176891
Name:KHODER, LUCIA
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:KHODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:PATRICIA
Other - Last Name:SOUSA RIBEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:560 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 615
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-6802
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:
Practice Address - Street 1:358 N BROADWAY
Practice Address - Street 2:SUITE #203
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2322
Practice Address - Country:US
Practice Address - Phone:914-631-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002694-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist