Provider Demographics
NPI:1154690105
Name:LATHAM, CRAIG (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:LATHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-9510
Mailing Address - Country:US
Mailing Address - Phone:508-650-4800
Mailing Address - Fax:
Practice Address - Street 1:291 PATTEN RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370
Practice Address - Country:US
Practice Address - Phone:508-650-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3349103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent