Provider Demographics
NPI:1679997100
Name:LATIN AMERICAN INSTITUTE
Entity Type:Organization
Organization Name:LATIN AMERICAN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LCADC,CASAC
Authorized Official - Phone:201-289-2832
Mailing Address - Street 1:10 BANTA PL STE 110
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5605
Mailing Address - Country:US
Mailing Address - Phone:201-525-1700
Mailing Address - Fax:201-525-0544
Practice Address - Street 1:10 BANTA PL STE 110
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5605
Practice Address - Country:US
Practice Address - Phone:201-525-1700
Practice Address - Fax:201-525-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000433261QM0850X, 261QM0855X, 261QM1300X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder