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NPI Code Detail

MEDICARE: JESSICA MARIE LAFONTAINE

MEDICARE: JESSICA MARIE LAFONTAINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1962035907
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE LAFONTAINE
Provider Business Mailing Address
First Line : 630 S WICKHAM RD STE 107
Second Line :
City : WEST MELBOURNE
State : FL
Zip : 32904-1429
Country : US
Telephone Number : 321-608-0604
Fax Number :
Provider Business Practice Location Address
First Line : 630 S WICKHAM RD STE 107
Second Line :
City : WEST MELBOURNE
State : FL
Zip : 32904-1429
Country : US
Telephone Number : 321-608-0604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2020
Last Update Date : 03/22/2021

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Directions to “ JESSICA MARIE LAFONTAINE ” Practice Location

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