Provider Demographics
NPI:1902916372
Name:LATTANZIO, CRYSTAL
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:LATTANZIO
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 1:930 OLD HARMONY RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4161
Mailing Address - Country:US
Mailing Address - Phone:302-731-4818
Mailing Address - Fax:302-239-5262
Practice Address - Street 1:930 OLD HARMONY RD STE A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4161
Practice Address - Country:US
Practice Address - Phone:302-731-4818
Practice Address - Fax:302-239-5262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional