Provider Demographics
NPI:1205110475
Name:LATCHMAN, PUJITA JESSICA
Entity type:Individual
Prefix:
First Name:PUJITA
Middle Name:JESSICA
Last Name:LATCHMAN
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 1:111 MYRTLE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2535
Mailing Address - Country:US
Mailing Address - Phone:510-839-3800
Mailing Address - Fax:510-835-4684
Practice Address - Street 1:1255 ALLSTON WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1833
Practice Address - Country:US
Practice Address - Phone:510-845-9010
Practice Address - Fax:510-849-1421
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist