Healthcare Provider Details

I. General information

NPI: 1306404348
Provider Name (Legal Business Name): ASYA LATIFOGLU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WEST ST APT 5A
BROOKLYN NY
11222-1975
US

IV. Provider business mailing address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

V. Phone/Fax

Practice location:
  • Phone: 443-240-4266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: