Basic Information
| Provider Information | |||||||||
| NPI: | 1003004292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAFOREST | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | MARQUES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COUNSELOR | ||||||||
| OtherOrganizationName: | |||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.