1306600291 NPI number — JOSEPH XAVIER LATELLA JR. LMSW

Table of content: JOSEPH XAVIER LATELLA JR. LMSW (NPI 1306600291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306600291 NPI number — JOSEPH XAVIER LATELLA JR. LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LATELLA
Provider First Name:
JOSEPH
Provider Middle Name:
XAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
LMSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306600291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 UNIVERSITY AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50314-2355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-248-1447
Provider Business Mailing Address Fax Number:
515-248-1490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 LAUREL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50314-3024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-612-9595
Provider Business Practice Location Address Fax Number:
515-346-6721
Provider Enumeration Date:
02/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  008237 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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