Healthcare Provider Details

I. General information

NPI: 1497675003
Provider Name (Legal Business Name): IYANNA LATIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 STADLEY ROUGH RD
DANBURY CT
06811-3238
US

IV. Provider business mailing address

58 STADLEY ROUGH RD
DANBURY CT
06811-3238
US

V. Phone/Fax

Practice location:
  • Phone: 203-885-4760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16157
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: