Provider Demographics
NPI: | 1942346531 |
---|---|
Name: | LAFERNEY, MICHAEL C (CNS) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | C |
Last Name: | LAFERNEY |
Suffix: | |
Gender: | M |
Credentials: | CNS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 88 PICKENS ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEVILLE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02347-1902 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-946-1755 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 100 LEDGEWOOD PL |
Practice Address - Street 2: | SUITE 202 |
Practice Address - City: | ROCKLAND |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02370-1075 |
Practice Address - Country: | US |
Practice Address - Phone: | 781-871-6550 |
Practice Address - Fax: | 781-871-5973 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-30 |
Last Update Date: | 2019-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 149852 | 364S00000X, 364SP0808X, 364SP0812X, 364SP0809X, 364SP0813X |
MA | 14982 | 364SP0811X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult |
No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | |
No | 364SP0811X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Chronically Ill |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health |
No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community |
No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | NS0199 | Medicare ID - Type Unspecified |