Provider Demographics
NPI:1407542236
Name:LATTUCA, KRISTA
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:LATTUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LONG POND RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1180
Mailing Address - Country:US
Mailing Address - Phone:585-415-9770
Mailing Address - Fax:
Practice Address - Street 1:1100 LONG POND RD STE 210
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1180
Practice Address - Country:US
Practice Address - Phone:585-415-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36691101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)