Basic Information
| Provider Information | |||||||||
| NPI: | 1740310150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANDRA | ||||||||
| FirstName: | LALITA | ||||||||
| MiddleName: | RAKESH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A PSYCHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4370 KISSENA BLVD | ||||||||
| Address2: | APT. NO. 19 D | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113553769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188999810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8708 JUSTICE AVE | ||||||||
| Address2: | SUITE C-7 | ||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113734575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188999810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.