Provider Demographics
NPI:1376913103
Name:LAFONTAINE, DENISE MICHELLE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:LAFONTAINE
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 1:199 ROSEWOOD DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1398
Mailing Address - Country:US
Mailing Address - Phone:617-226-3227
Mailing Address - Fax:617-266-3144
Practice Address - Street 1:199 ROSEWOOD DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1398
Practice Address - Country:US
Practice Address - Phone:617-226-3227
Practice Address - Fax:617-266-3144
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)