Provider Demographics
NPI:1295149292
Name:GREEN-BOYD, LATASHA LANEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:LANEE
Last Name:GREEN-BOYD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 NUTTALL OAKS PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2179
Mailing Address - Country:US
Mailing Address - Phone:813-999-3001
Mailing Address - Fax:813-819-2619
Practice Address - Street 1:710 OAKFIELD DR STE 221
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4924
Practice Address - Country:US
Practice Address - Phone:813-999-3001
Practice Address - Fax:813-819-2619
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2025-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4927106H00000X
FLSW112071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist