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Individual
MR. JEFFREY LAFORGE
Active
Individual
MR. JEFFREY LAFORGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004995
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510546568
CIGNA PROVIDER ID
NC
05
—
6106088
—
NC
01
—
7651956
AETNA PROVIDER ID
NC
01
—
C004995
SOC WORK LICENSE NUM
NC
Enumeration date
10/18/2006
Last updated
06/03/2010
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