Healthcare Provider Details

I. General information

NPI: 1982290714
Provider Name (Legal Business Name): THE LATIN ENRICHMENT ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 FOREST ST
HARTFORD CT
06105-3204
US

IV. Provider business mailing address

PO BOX 380322
HARTFORD CT
06138-0322
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-0975
  • Fax: 860-249-0975
Mailing address:
  • Phone: 860-249-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLOS MARRERO
Title or Position: CLINIC DIRECTOR
Credential: MSW, ACSW
Phone: 860-249-0975