Provider Demographics
NPI:1457647398
Name:LAFAYETTE, LOIS NEAL (MA)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:NEAL
Last Name:LAFAYETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4907
Mailing Address - Country:US
Mailing Address - Phone:718-450-0074
Mailing Address - Fax:718-622-3720
Practice Address - Street 1:227 WEST 29TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:718-450-0074
Practice Address - Fax:718-622-3720
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241033881174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator