Basic Information
Provider Information
NPI: 1912417411
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STERLING
FirstName: LATISHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: 2408 CLARENDON RD APT 4D
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112266296
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1847 MOTT AVE FL 2
Address2:  
City: FAR ROCKAWAY
State: NY
PostalCode: 116914201
CountryCode: US
TelephoneNumber: 7183376800
FaxNumber: 7183376800
Other Information
ProviderEnumerationDate: 10/10/2017
LastUpdateDate: 10/10/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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