MEDICARE: KATHLEEN M LATTEA LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC0367	MD

General Provider Information

NPI Number	:	1730245887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M LATTEA LCPC

Provider Business Mailing Address
First Line	:	16209 OLD FREDERICK RD
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-3346
Country	:	US
Telephone Number	:	301-748-2308
Fax Number	:	301-662-6966

Provider Business Practice Location Address
First Line	:	1011 E PATRICK ST
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21701-3119
Country	:	US
Telephone Number	:	301-662-6966
Fax Number	:	301-662-6966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	03/01/2008

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