Provider Demographics
NPI:1306098728
Name:BOND, LATISHA
Entity type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:
Last Name:BOND
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 1:44 PAUL DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-1928
Mailing Address - Country:US
Mailing Address - Phone:631-806-3760
Mailing Address - Fax:631-399-1405
Practice Address - Street 1:44 PAUL DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-1928
Practice Address - Country:US
Practice Address - Phone:631-806-3760
Practice Address - Fax:631-399-1405
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X, 171M00000X, 171W00000X, 172V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker