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NPI Code Detail

MEDICARE: DR. DANIEL JOHN LATENDRESSE PSYD

MEDICARE: DR. DANIEL JOHN LATENDRESSE PSYD
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
1103TC0700XClinical Psychologist015946NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841360112
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL JOHN LATENDRESSE PSYD
Provider Business Mailing Address
First Line : 299 SAINT MARKS PL
Second Line : APT 408
City : STATEN ISLAND
State : NY
Zip : 10301-1859
Country : US
Telephone Number : 718-744-4753
Fax Number :
Provider Business Practice Location Address
First Line : 1657 BEDFORD AVE
Second Line : SUITE 2A
City : BROOKLYN
State : NY
Zip : 11225-2009
Country : US
Telephone Number : 718-363-3261
Fax Number : 718-363-5074
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 07/08/2007

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