Provider Demographics
NPI:1225246507
Name:LAFORTE, DEBORAH L
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:L
Last Name:LAFORTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W SENECA ST APT 16F
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2348
Mailing Address - Country:US
Mailing Address - Phone:315-682-6104
Mailing Address - Fax:
Practice Address - Street 1:311 W SENECA ST APT 16F
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2348
Practice Address - Country:US
Practice Address - Phone:315-682-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238686-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02689870Medicaid