Provider Demographics
NPI:1952112864
Name:LATCHANA, ANGELA SABRINA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SABRINA
Last Name:LATCHANA
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 1:17906 BAISLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1956
Mailing Address - Country:US
Mailing Address - Phone:347-863-1676
Mailing Address - Fax:
Practice Address - Street 1:17906 BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1956
Practice Address - Country:US
Practice Address - Phone:347-863-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NYP133432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health