Provider Demographics
NPI:1326667288
Name:LAFRENIERE, CAROLE MARIE
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:MARIE
Last Name:LAFRENIERE
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 1:2904 SHADY KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4131
Mailing Address - Country:US
Mailing Address - Phone:682-715-5411
Mailing Address - Fax:817-510-3602
Practice Address - Street 1:2904 SHADY KNOLL LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4131
Practice Address - Country:US
Practice Address - Phone:682-715-5411
Practice Address - Fax:817-510-3602
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX615791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical