Healthcare Provider Details

I. General information

NPI: 1316864085
Provider Name (Legal Business Name): LEON LATINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5766
US

IV. Provider business mailing address

70 FLETCHER ST
ROSLINDALE MA
02131-1918
US

V. Phone/Fax

Practice location:
  • Phone: 781-650-2519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: