Provider Demographics
NPI:1205543022
Name:LATCHMAN, KERRI TIFFANY (RBT BS)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:TIFFANY
Last Name:LATCHMAN
Suffix:
Gender:F
Credentials:RBT BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7728 NW 5TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7900
Mailing Address - Country:US
Mailing Address - Phone:631-871-9441
Mailing Address - Fax:
Practice Address - Street 1:6950 CYPRESS RD STE 103
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2361
Practice Address - Country:US
Practice Address - Phone:954-399-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRBT-22-210117106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician