Provider Demographics
NPI:1437910668
Name:LATTA, NATALIE RENE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENE
Last Name:LATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOAH
Other - Middle Name:RENE
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:640 FREEDOM BUSINESS CTR DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5021 LOUISE DR STE C
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-9801
Practice Address - Country:US
Practice Address - Phone:484-393-4107
Practice Address - Fax:484-231-8631
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-24-320729106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician