Provider Demographics
NPI:1588252621
Name:LAFRENIERE, LEAH REED
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:REED
Last Name:LAFRENIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 AVALON DR E
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3643
Mailing Address - Country:US
Mailing Address - Phone:631-680-0008
Mailing Address - Fax:
Practice Address - Street 1:501 KINGS HWY E STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4864
Practice Address - Country:US
Practice Address - Phone:203-255-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008613235Z00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist