Provider Demographics
NPI:1841862331
Name:SOARES, LETICIA BARBOSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:BARBOSA
Last Name:SOARES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27209 TOWN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1692
Mailing Address - Country:US
Mailing Address - Phone:561-667-2152
Mailing Address - Fax:
Practice Address - Street 1:27209 TOWN GREEN DR
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1692
Practice Address - Country:US
Practice Address - Phone:347-541-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24307103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist