Healthcare Provider Details

I. General information

NPI: 1487039145
Provider Name (Legal Business Name): JENNIFER E LAFORGE LCSW , MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

2440A MENDON RD
CUMBERLAND RI
02864-3728
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4530
  • Fax:
Mailing address:
  • Phone: 401-316-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW01535
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01535
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: