Provider Demographics
NPI:1750682407
Name:LAYNE, LETTICE CHANTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:LETTICE
Middle Name:CHANTINA
Last Name:LAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 VANDALIA AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2814
Mailing Address - Country:US
Mailing Address - Phone:718-473-6827
Mailing Address - Fax:
Practice Address - Street 1:627 VANDALIA AVE # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2814
Practice Address - Country:US
Practice Address - Phone:718-473-6827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080384104100000X
0862521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker