Provider Demographics
NPI:1083804454
Name:LATIN AMERICAN COMMUNITY CENTER
Entity Type:Organization
Organization Name:LATIN AMERICAN COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH PROGRAM
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-295-2169
Mailing Address - Street 1:403 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3243
Mailing Address - Country:US
Mailing Address - Phone:302-655-7338
Mailing Address - Fax:302-655-7334
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3612
Practice Address - Country:US
Practice Address - Phone:302-295-2160
Practice Address - Fax:302-655-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health