Individual
MS. MARY ELIZABETH LATENDRESSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
218 WASHINGTON AVE, PORTLAND, ME 04101-2632
(207) 773-5778
(207) 773-5773
Mailing address
30 PREBLE ST, APT 553, PORTLAND, ME 04101-4936
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT2239
ME
Other
Enumeration date
11/16/2011
Last updated
07/17/2012
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