Basic Information
Provider Information
NPI: 1003004292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAFOREST
FirstName: JEAN
MiddleName: MARQUES
NamePrefix: MR.
NameSuffix:  
Credential: COUNSELOR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 230 HIGHLAND AVE
Address2: S.O.N, ROOM 401
City: SOMERVILLE
State: MA
PostalCode: 021431408
CountryCode: US
TelephoneNumber: 6175916780
FaxNumber: 6175916784
Practice Location
Address1: 230 HIGHLAND AVE
Address2: S.O.N, ROOM 401
City: SOMERVILLE
State: MA
PostalCode: 021431408
CountryCode: US
TelephoneNumber: 6175916780
FaxNumber: 6175916784
Other Information
ProviderEnumerationDate: 10/12/2007
LastUpdateDate: 10/12/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
172V00000X  Y Other Service ProvidersCommunity Health Worker 

No ID Information.


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