Provider Demographics
NPI:1548748940
Name:LAFFERTY, WILLIAM PETER
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:LAFFERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1902
Mailing Address - Country:US
Mailing Address - Phone:508-384-1638
Mailing Address - Fax:508-384-5562
Practice Address - Street 1:131 EMERALD ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1902
Practice Address - Country:US
Practice Address - Phone:508-384-1638
Practice Address - Fax:508-384-5562
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA107234OtherSTATE OF MASSA