1336223841 NPI number — DAVID N LAPORTE LICSW

Table of content: DAVID N LAPORTE LICSW (NPI 1336223841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336223841 NPI number — DAVID N LAPORTE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAPORTE
Provider First Name:
DAVID
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336223841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 STAFFORD RD APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIVERTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02878-2559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-496-0007
Provider Business Mailing Address Fax Number:
508-998-2176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
699 STATE RD UNIT 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02790-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-496-0007
Provider Business Practice Location Address Fax Number:
508-998-2176
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1019427 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1858793 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123180 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 123180 . This is a "TRI CARE VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: LAP05624 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 123180 . This is a "GREAT WEST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 239109 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1748592 . This is a "UBH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 129181000 . This is a "MAGELLAN BEH HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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