Most Relevant Information
Provider Data
NPI Number: | 1003290305 |
Provider Name: | LISA ANN LATAILLE LMSW |
Entity Type: | Individual |
Taxonomy Code: | 104100000X |
Specialty: | Social Worker |
License Number: | 047476-1 |
Most Important Dates
Enumeration Date: | 07/16/2015 |
Last Updated: | 07/16/2015 |
Provider Practice Location
18 COURT ST
VALLEY STREAM
NY
115803202
Practice Location Phone/Fax
Phone: | 5168373368 |
Fax: |
Provider Mailing Location
18 COURT ST
VALLEY STREAM
NY
115803202
Provider Mailing Phone/Fax
Phone: | 5168373368 |
Fax: |