Healthcare Provider Details

I. General information

NPI: 1043612559
Provider Name (Legal Business Name): YOLETTE LATORTUE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ROSCOE CT
GREENVALE NY
11548-1143
US

IV. Provider business mailing address

2 ROSCOE CT
GREENVALE NY
11548-1143
US

V. Phone/Fax

Practice location:
  • Phone: 516-770-4060
  • Fax:
Mailing address:
  • Phone: 516-770-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number083031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: