Provider Demographics
NPI:1578854550
Name:LATIMER, L'CORIUS M (MA)
Entity Type:Individual
Prefix:MS
First Name:L'CORIUS
Middle Name:M
Last Name:LATIMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1325 5TH AVE
Mailing Address - Street 2:APT # 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2660
Mailing Address - Country:US
Mailing Address - Phone:917-561-3967
Mailing Address - Fax:212-426-7927
Practice Address - Street 1:3310 QUEENS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2660
Practice Address - Country:US
Practice Address - Phone:718-593-4121
Practice Address - Fax:718-268-2646
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist