Provider Demographics
NPI:1760532626
Name:LAFEMINA, PHILIP SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:SCOTT
Last Name:LAFEMINA
Suffix:
Gender:M
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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-0194
Mailing Address - Country:US
Mailing Address - Phone:860-564-2323
Mailing Address - Fax:860-564-2696
Practice Address - Street 1:50 ACADEMY HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1600
Practice Address - Country:US
Practice Address - Phone:860-564-2323
Practice Address - Fax:860-564-2696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003808104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002023Medicare ID - Type Unspecified