Healthcare Provider Details

I. General information

NPI: 1134972607
Provider Name (Legal Business Name): LATASHIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N 4TH ST
BROOKLYN NY
11249-3296
US

IV. Provider business mailing address

80 N MOORE ST APT 30J
NEW YORK NY
10013-2735
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-7748
  • Fax: 718-481-2061
Mailing address:
  • Phone: 646-729-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P137655-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: