Provider Demographics
NPI:1992362495
Name:ISLER, LATHYRELLE ALEASE
Entity Type:Individual
Prefix:MS
First Name:LATHYRELLE
Middle Name:ALEASE
Last Name:ISLER
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 1:7405 LANDSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-4717
Mailing Address - Country:US
Mailing Address - Phone:718-864-9150
Mailing Address - Fax:
Practice Address - Street 1:1901 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-2377
Practice Address - Country:US
Practice Address - Phone:302-631-5600
Practice Address - Fax:302-454-5453
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE98345103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool