Provider Demographics
NPI:1326659012
Name:LAFO, JACOB ADRIAN (PHD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ADRIAN
Last Name:LAFO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY STE 8B
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5315
Mailing Address - Country:US
Mailing Address - Phone:401-529-4884
Mailing Address - Fax:401-519-6619
Practice Address - Street 1:593 EDDY ST STE 430
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4500
Practice Address - Fax:401-444-6643
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01845103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical