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: |