Provider Demographics
NPI:1598804239
Name:LAPORTE, JENNIFER F (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:F
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1955 U.S. 1 SOUTH, SUITE 200
Mailing Address - Street 2:ST. AUGUSTINE COMMUNITY BASED OUTPATIENT CLINIC/VETERAN
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-829-0814
Mailing Address - Fax:904-829-6174
Practice Address - Street 1:1955 U.S. 1 SOUTH, SUITE 200
Practice Address - Street 2:ST. AUGUSTINE COMMUNITY BASED OUTPATIENT CLINIC/VETERAN
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-829-0814
Practice Address - Fax:904-829-6174
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007831041C0700X
FLSW99781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041085Medicaid