Healthcare Provider Details

I. General information

NPI: 1598805335
Provider Name (Legal Business Name): LATIN AMERICAN YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 COLUMBIA RD NW
WASHINGTON DC
20009-4705
US

IV. Provider business mailing address

1419 COLUMBIA RD NW
WASHINGTON DC
20009-4705
US

V. Phone/Fax

Practice location:
  • Phone: 202-319-2225
  • Fax: 202-462-5696
Mailing address:
  • Phone: 202-319-2225
  • Fax: 202-462-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number036392800
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number102600A-Y-027
License Number StateDC

VIII. Authorized Official

Name: MS. LORI KAPLAN
Title or Position: CEO
Credential:
Phone: 202-319-8642