Provider Demographics
NPI:1033452982
Name:LATIMER, WILLIAM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:LATIMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 BAYARD STREET BOX #724
Mailing Address - Street 2:
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466
Mailing Address - Country:US
Mailing Address - Phone:646-249-5767
Mailing Address - Fax:
Practice Address - Street 1:243 BAYARD STREET BOX #724
Practice Address - Street 2:
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466
Practice Address - Country:US
Practice Address - Phone:646-249-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0805791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03589764Medicaid
NY03589764Medicaid