Individual
DR. MARY SUE P LAFFERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2530 CRAWFORD AVE, #304, EVANSTON, IL 60201-4970
(847) 475-8625
(847) 869-8116
Mailing address
2530 CRAWFORD AVE, #304, EVANSTON, IL 60201-4970
(847) 475-8625
(847) 869-8116
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004575
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001673728
BLUE CROSS
IL
05
—
245190
—
IL
Enumeration date
10/23/2006
Last updated
01/16/2015
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