Provider Demographics
NPI:1811124761
Name:LAJARA, JOHN DANIEL (LISW-CP (LCSW))
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DANIEL
Last Name:LAJARA
Suffix:
Gender:M
Credentials:LISW-CP (LCSW)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-1025
Mailing Address - Country:US
Mailing Address - Phone:854-290-6828
Mailing Address - Fax:
Practice Address - Street 1:102 BUCKWALTER PARKWAY
Practice Address - Street 2:SUITE 3UV
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4132
Practice Address - Country:US
Practice Address - Phone:843-290-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC143971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039946OtherLCSW-R
NY11628OtherEARLY INTERVENTION SERVICES