Provider Demographics
NPI:1902007792
Name:LAFONTAINE, DAVID MARC (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARC
Last Name:LAFONTAINE
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 14745
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0148
Mailing Address - Country:US
Mailing Address - Phone:314-479-1007
Mailing Address - Fax:
Practice Address - Street 1:86 MDG UNIT 3215
Practice Address - Street 2:RAMSTEIN AB
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094
Practice Address - Country:US
Practice Address - Phone:314-479-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY0350381041C0700X
NYR035038-11041C0700X
NYR0350381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical