Healthcare Provider Details

I. General information

NPI: 1104737683
Provider Name (Legal Business Name): CAROLINE MARIE LATIOLAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S SHORE TER # 1
PRINCE FREDERICK MD
20678-4809
US

IV. Provider business mailing address

350 S SHORE TER # 1
PRINCE FREDERICK MD
20678-4809
US

V. Phone/Fax

Practice location:
  • Phone: 504-444-3285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: