Provider Demographics
NPI:1609907252
Name:LAFLECHE, GINETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINETTE
Middle Name:
Last Name:LAFLECHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BRAHMS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4011
Mailing Address - Country:US
Mailing Address - Phone:617-323-0753
Mailing Address - Fax:
Practice Address - Street 1:27 BRAHMS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131-4011
Practice Address - Country:US
Practice Address - Phone:617-323-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6747103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05423OtherMEDEX
MA447534OtherTUFTS
MAW05423OtherMEDEX