Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS01901 | RI |
NPI | 1023688512 |
---|---|
Provider Name | Dr. Tonya Lynn Latzman |
First Address | Cranston, RI 02921-1242 |
Second Address | Cranston, RI 02921-1242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 28/06/2021 |