Provider Demographics
NPI:1356462741
Name:LATZ, MARTHA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:G
Last Name:LATZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 CAMINO REAL STE 302
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-300-4066
Mailing Address - Fax:561-409-4383
Practice Address - Street 1:7100 CAMINO REAL STE 302
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-300-4066
Practice Address - Fax:561-409-4383
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist