DR. Lea Athena Theodore, PH.D.

NPI #1306920806 in Oakdale, New York

Provider Information

NPI Number: 1306920806
Entity Type: Individual
Name: DR. Lea Athena Theodore, PH.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist
Credential: PH.D.
Enumeration Date: Oct 24, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 1563 MONTAUK HWY
City: Oakdale
State: New York
ZIP Code: 11769-1322
Phone: (631) 563-3162

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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