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NPI Code Detail

MEDICARE: MR. ERICK JAMES LATTRELL LICSW

MEDICARE: MR. ERICK JAMES LATTRELL LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker089.0134160VT

General Provider Information

NPI Number : 1679040646
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERICK JAMES LATTRELL LICSW
Provider Business Mailing Address
First Line : 10 PEARL ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3604
Country : US
Telephone Number : 802-865-3450
Fax Number :
Provider Business Practice Location Address
First Line : 10 PEARL ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3604
Country : US
Telephone Number : 802-865-3450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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