Provider Demographics
NPI:1043582026
Name:LATCHMAN, LELLIETH (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:LELLIETH
Middle Name:
Last Name:LATCHMAN
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MS
Other - First Name:LELLIETH
Other - Middle Name:
Other - Last Name:KEIZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ELMCREST TER APT 11
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3971
Mailing Address - Country:US
Mailing Address - Phone:203-956-0976
Mailing Address - Fax:
Practice Address - Street 1:101 MERRITT 7 STE 300
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1059
Practice Address - Country:US
Practice Address - Phone:475-889-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT965780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered