Provider Demographics
NPI:1780132597
Name:LEE, LATRECE
Entity type:Individual
Prefix:
First Name:LATRECE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATRECE
Other - Middle Name:AUTUMN
Other - Last Name:HAGANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:61 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1303
Mailing Address - Country:US
Mailing Address - Phone:973-914-3437
Mailing Address - Fax:
Practice Address - Street 1:61 E 33RD ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1303
Practice Address - Country:US
Practice Address - Phone:973-914-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst