Provider Demographics
NPI:1477845410
Name:LATORE, JILL A (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:LATORE
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 1:1107 DUSHANE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4781
Mailing Address - Country:US
Mailing Address - Phone:724-944-2746
Mailing Address - Fax:
Practice Address - Street 1:2703 W STATE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-8671
Practice Address - Country:US
Practice Address - Phone:724-657-3303
Practice Address - Fax:724-657-3326
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126944104100000X
PACW0173611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251830792OtherUNITED BEHAVIORAL HEALTH
PA600773304OtherMAGELLAN HEALTH SERVICES
PA1477845410OtherHIGHMARK BLUE SHIELD