Healthcare Provider Details

I. General information

NPI: 1760433833
Provider Name (Legal Business Name): MABEL LAFONTAINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date: 12/07/2018
Reactivation Date: 12/31/2018

III. Provider practice location address

16201 POWELLS COVE BLVD APT 3K
WHITESTONE NY
11357-1408
US

IV. Provider business mailing address

162-01 POWELLS COVE BLVD APT 3K
WHITESTONE NY
11357-1414
US

V. Phone/Fax

Practice location:
  • Phone: 646-772-0752
  • Fax:
Mailing address:
  • Phone: 646-772-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number-059528-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: