Healthcare Provider Details

I. General information

NPI: 1598804239
Provider Name (Legal Business Name): JENNIFER F. LAPORTE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BAY BRIDGE DR
ST AUGUSTINE FL
32080-6608
US

IV. Provider business mailing address

101 BAY BRIDGE DR
ST AUGUSTINE FL
32080-6608
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-3759
  • Fax: 904-587-1564
Mailing address:
  • Phone: 904-372-3759
  • Fax: 904-587-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9978
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000783
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: