Provider Demographics
NPI:1235451667
Name:LACANFORA, PETER S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:LACANFORA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SEAVER FARM LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1222
Mailing Address - Country:US
Mailing Address - Phone:774-437-9723
Mailing Address - Fax:
Practice Address - Street 1:7 SEAVER FARM LN
Practice Address - Street 2:
Practice Address - City:SOUTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01560-1222
Practice Address - Country:US
Practice Address - Phone:774-437-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical