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General NPI Number Information
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NPI Number | 1801913181
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Entity Type | Individual
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Provider Name | TAMARA LATAWIEC PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 43 W FRONT ST STE 18
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City | RED BANK
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State | NJ
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Zip | 07701-1600
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Country | US
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Telephone | 732-720-3236
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Fax |
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Provider Business Mailing Address
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Address Line | 43 W FRONT ST STE 18
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City | RED BANK
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State | NJ
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Zip | 07701-1600
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Country | US
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Telephone | 732-720-3236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4894
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License Number State | NJ
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