MEDICARE: MR. JUSTIN M LAFFOON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3639-C	AR

General Provider Information

NPI Number	:	1548469059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN M LAFFOON LCSW

Provider Business Mailing Address
First Line	:	2318 S SUMMIT ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-1764
Country	:	US
Telephone Number	:	501-686-8145
Fax Number	:	501-526-6280

Provider Business Practice Location Address
First Line	:	21 BRIDGEWAY RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-9516
Country	:	US
Telephone Number	:	501-687-8633
Fax Number	:	501-771-8509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	01/16/2025

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