Individual
DR. JESSICA LATACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
200 W 57TH ST STE 507, NEW YORK, NY 10019-3211
(917) 817-2422
Mailing address
115 W 86TH ST, NEW YORK, NY 10024-3410
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
022815
NY
Other
Enumeration date
11/16/2017
Last updated
08/19/2019
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