Provider Demographics
NPI:1265972681
Name:LATANYA BIZOR, LCSW,LLC
Entity type:Organization
Organization Name:LATANYA BIZOR, LCSW,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIZOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:203-214-9437
Mailing Address - Street 1:969 W MAIN ST
Mailing Address - Street 2:STE 2G
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2653
Mailing Address - Country:US
Mailing Address - Phone:475-275-8245
Mailing Address - Fax:
Practice Address - Street 1:969 W MAIN ST
Practice Address - Street 2:STE 2G
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2653
Practice Address - Country:US
Practice Address - Phone:475-275-8245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-04
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0093031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty