Healthcare Provider Details

I. General information

NPI: 1144140971
Provider Name (Legal Business Name): MRS. JASMINE NATACHA LAFORTUNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST
DANVERS MA
01923-2763
US

IV. Provider business mailing address

75 SYLVAN ST
DANVERS MA
01923-2763
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7566
  • Fax:
Mailing address:
  • Phone: 857-829-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberRN2261689
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: