MEDICARE: LATONERCUS STARR STEEN CCSS

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
1	373H00000X	Day Training/Habilitation Specialist
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1962682096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONERCUS STARR STEEN CCSS

Provider Business Mailing Address
First Line	:	2017 YALE BLVD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4817
Country	:	US
Telephone Number	:	505-300-4655
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 YALE BLVD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4817
Country	:	US
Telephone Number	:	505-300-4655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	01/27/2026

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