Provider Demographics
NPI:1588168991
Name:LACOURT, OMAYRA (ASSOCIATE DEGREE)
Entity type:Individual
Prefix:
First Name:OMAYRA
Middle Name:
Last Name:LACOURT
Suffix:
Gender:F
Credentials:ASSOCIATE DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 BEACH AVE APT 4O
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-6346
Mailing Address - Country:US
Mailing Address - Phone:646-301-1941
Mailing Address - Fax:
Practice Address - Street 1:1574 BEACH AVE APT 4O
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-6346
Practice Address - Country:US
Practice Address - Phone:646-301-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator