Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 047476-1 | NY |
NPI | 1003290305 |
---|---|
Provider Name | Mrs. Lisa Ann Lataille |
First Address | Valley Stream, NY 11580-3202 |
Second Address | Valley Stream, NY 11580-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2015 |
Last Update Date | 16/07/2015 |