Provider Demographics
NPI:1467757286
Name:LAFRENIERE, CHRISSY
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:
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 1:1770 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3133
Mailing Address - Country:US
Mailing Address - Phone:321-890-1504
Mailing Address - Fax:
Practice Address - Street 1:1770 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3133
Practice Address - Country:US
Practice Address - Phone:321-890-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health