Provider Demographics
NPI:1760433833
Name:LAFONTAINE, MABEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MABEL
Middle Name:
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162-01 POWELLS COVE BLVD APT 3K
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1414
Mailing Address - Country:US
Mailing Address - Phone:646-772-0752
Mailing Address - Fax:
Practice Address - Street 1:16201 POWELLS COVE BLVD APT 3K
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1408
Practice Address - Country:US
Practice Address - Phone:646-772-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2018-12-31
Deactivation Date:2018-12-07
Deactivation Code:
Reactivation Date:2018-12-31
Provider Licenses
StateLicense IDTaxonomies
NY-059528-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical