Provider Demographics
NPI:1467793919
Name:MARGARET ANGELYN BUSH LATTA, LCSW
Entity Type:Organization
Organization Name:MARGARET ANGELYN BUSH LATTA, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANGELYN
Authorized Official - Last Name:LATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-209-6638
Mailing Address - Street 1:10150 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6526
Mailing Address - Country:US
Mailing Address - Phone:954-474-8757
Mailing Address - Fax:954-474-8757
Practice Address - Street 1:7390 NW 5TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1610
Practice Address - Country:US
Practice Address - Phone:601-209-6638
Practice Address - Fax:954-583-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS87601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty