Provider Demographics
NPI:1679977219
Name:STANLEY, LAITYA
Entity Type:Individual
Prefix:
First Name:LAITYA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 SHORE PKWY
Mailing Address - Street 2:SUITE C1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3360 SHORE PKWY
Practice Address - Street 2:SUITE C1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2716
Practice Address - Country:US
Practice Address - Phone:718-769-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker