Provider Demographics
NPI:1952467011
Name:TRAFICONTE, LAURIE S (MSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:S
Last Name:TRAFICONTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GRENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4917
Mailing Address - Country:US
Mailing Address - Phone:617-926-1086
Mailing Address - Fax:617-926-5448
Practice Address - Street 1:50 TRAPELO RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4447
Practice Address - Country:US
Practice Address - Phone:617-926-5448
Practice Address - Fax:617-926-5448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22218Medicare ID - Type UnspecifiedMEDICARE ID NUMBER