Provider Demographics
NPI:1295435329
Name:NANNAN, LATOYA (LCSW)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:NANNAN
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 1:590 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1721
Mailing Address - Country:US
Mailing Address - Phone:201-503-4304
Mailing Address - Fax:
Practice Address - Street 1:590 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1721
Practice Address - Country:US
Practice Address - Phone:201-503-4304
Practice Address - Fax:201-328-9404
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05979600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health