Provider Demographics
NPI:1568836567
Name:MCLEOD, LATOYA (LMSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17220 133RD AVE
Mailing Address - Street 2:APT 4B
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3961
Mailing Address - Country:US
Mailing Address - Phone:347-693-6628
Mailing Address - Fax:
Practice Address - Street 1:17220 133RD AVE
Practice Address - Street 2:APT 4B
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3961
Practice Address - Country:US
Practice Address - Phone:347-693-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090745104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker