Provider Demographics
NPI:1194257667
Name:LAFOME, FELICIA ROSA (MSW)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:ROSA
Last Name:LAFOME
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:GRIFFIN HOSPITAL
Mailing Address - Street 2:130 DIVISION STREET
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-732-7550
Mailing Address - Fax:203-732-1550
Practice Address - Street 1:GRIFFIN HOSPITAL
Practice Address - Street 2:130 DIVISION STREET
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-732-7550
Practice Address - Fax:203-732-1550
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025219Medicaid
CT004041927Medicaid