Provider Demographics
NPI:1245460773
Name:LAFONTAINE, JULIA N (SW)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:N
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5-11 BO GUAYANEY
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4218
Mailing Address - Country:US
Mailing Address - Phone:787-619-6522
Mailing Address - Fax:787-915-6830
Practice Address - Street 1:5-11 BO GUAYANEY
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4218
Practice Address - Country:US
Practice Address - Phone:787-619-6522
Practice Address - Fax:787-915-6830
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2523101YP2500X
PR7560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker