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General NPI Number Information
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NPI Number | 1912437443
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Entity Type | Individual
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Provider Name | KIMBERLY LATTA PH.D, MA, LSW
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Gender | Female
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 06/18/2017
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Provider Practice Location Address
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Address Line | 1201 N MAIN STREET EXT
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City | BUTLER
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State | PA
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Zip | 16001-1537
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Country | US
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Telephone | 724-287-5449
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Fax |
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Provider Business Mailing Address
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Address Line | 5554 WELLESLEY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15206-1443
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Country | US
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Telephone | 412-719-2735
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW131655
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License Number State | PA
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