Provider Demographics
NPI:1568823557
Name:LATIMORE, MONA DANIALI (MSW)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:DANIALI
Last Name:LATIMORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:DANIALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 VERMONT AVE NW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-3516
Mailing Address - Country:US
Mailing Address - Phone:202-293-4580
Mailing Address - Fax:
Practice Address - Street 1:1025 VERMONT AVE NW
Practice Address - Street 2:SUITE 310
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3516
Practice Address - Country:US
Practice Address - Phone:202-293-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500808281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical