Provider Demographics
NPI:1922234806
Name:LATHROP, BRIAN ALBERT (MDIV, LP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALBERT
Last Name:LATHROP
Suffix:
Gender:M
Credentials:MDIV, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WASHINGTON SQ W
Mailing Address - Street 2:SUITE 6 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9126
Mailing Address - Country:US
Mailing Address - Phone:212-228-9504
Mailing Address - Fax:
Practice Address - Street 1:31 WASHINGTON SQ W
Practice Address - Street 2:SUITE 6 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9126
Practice Address - Country:US
Practice Address - Phone:212-228-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000677-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst