Individual
JOANNE LATAILLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
720 HARRISON AVE, DOCTORS OFFICE BUILDING, SUITE 914, BOSTON, MA 02118-2371
(617) 638-8540
Mailing address
940 BELMONT ST BLDG 2A-204, BROCKTON, MA 02301-5596
(774) 826-3155
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
303372
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303372
—
NY
Enumeration date
03/22/2016
Last updated
11/27/2023
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