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General NPI Number Information
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NPI Number | 1821638982
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Entity Type | Individual
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Provider Name | LATICIA FRANCIS BA, CASAC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 375 SEGUINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3932
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Country | US
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Telephone | 718-226-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 392 SEGUINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3906
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Country | US
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Telephone | 718-226-2800
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Fax | 718-226-2964
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 26156
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License Number State | NY
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