Provider Demographics
NPI:1013064229
Name:MANASSE-LATHAM, LAUREN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MANASSE-LATHAM
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4228
Mailing Address - Country:US
Mailing Address - Phone:617-363-9988
Mailing Address - Fax:
Practice Address - Street 1:3 THORNTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1519
Practice Address - Country:US
Practice Address - Phone:617-894-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10207341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical