Provider Demographics
NPI:1336223841
Name:LAPORTE, DAVID N (LICSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:LAPORTE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 STAFFORD RD APT 2
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2559
Mailing Address - Country:US
Mailing Address - Phone:508-496-0007
Mailing Address - Fax:508-998-2176
Practice Address - Street 1:699 STATE RD UNIT 5
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-2831
Practice Address - Country:US
Practice Address - Phone:508-496-0007
Practice Address - Fax:508-998-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858793Medicaid
MA123180OtherVALUE OPTIONS
MA123180OtherTRI CARE VALUE OPTIONS
MALAP05624OtherBCBS
MA123180OtherGREAT WEST
MA239109OtherBLUE CROSS BLUE SHIELD OF
MA1748592OtherUBH
MA129181000OtherMAGELLAN BEH HEALTH
MA239109OtherBLUE CROSS BLUE SHIELD OF