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General NPI Number Information
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NPI Number | 1629472931
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Entity Type | Organization
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Legal Business Name | JEFFREY LAFFERMAN
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 912 SUN CIRCLE WAY
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City | ESSEX
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State | MD
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Zip | 21221-5946
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Country | US
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Telephone | 410-428-6032
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Fax | 410-391-4381
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Provider Business Mailing Address
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Address Line | 912 SUN CIRCLE WAY
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City | ESSEX
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State | MD
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Zip | 21221-5946
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Country | US
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Telephone | 410-428-6032
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Fax | 410-391-4381
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Authorized Official
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Title or Position | PSYCHIATRIC CONSULTANT
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Name | MS. DEBORA MARIE FLOYD
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Credential | LCPC
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Telephone | 410-428-6032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LC5790
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License Number State | MD
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