Provider Demographics
NPI:1457123341
Name:LAFAYETTE, REMI (ACSW)
Entity Type:Individual
Prefix:
First Name:REMI
Middle Name:
Last Name:LAFAYETTE
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-1582
Mailing Address - Country:US
Mailing Address - Phone:805-612-1503
Mailing Address - Fax:
Practice Address - Street 1:1515 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4952
Practice Address - Country:US
Practice Address - Phone:805-612-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1027041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical