Provider Demographics
NPI:1932157351
Name:LAFRINIERE, MELODY LOU (PHD)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:LOU
Last Name:LAFRINIERE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:NM
Mailing Address - Zip Code:87830-0441
Mailing Address - Country:US
Mailing Address - Phone:505-259-6675
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:PSY CONSULTATION
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-272-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-05-07
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-02-20
Provider Licenses
StateLicense IDTaxonomies
NM0888103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21753067Medicaid