Provider Demographics
NPI:1962732990
Name:LAFFERTY, DOREEN FRANCES (LAC,OTR/L,NCTMB)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:FRANCES
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:LAC,OTR/L,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 ENGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1612
Mailing Address - Country:US
Mailing Address - Phone:215-720-4803
Mailing Address - Fax:
Practice Address - Street 1:3502 ENGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1612
Practice Address - Country:US
Practice Address - Phone:215-720-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist