Basic Information
| Provider Information | |||||||||
| NPI: | 1679822332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREIRA | ||||||||
| FirstName: | LILA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PEREIRA | ||||||||
| OtherFirstName: | LILA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | BOSTON CHILDRENS HEALTH PHYSICIANS | ||||||||
| Address2: | SUITE 800S | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MARIA FARERI CHILDRENS HOSPITAL | ||||||||
| Address2: | 100 WOODS RD | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937997 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2012 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 022617 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.