Provider Demographics
NPI:1003316415
Name:DOS SANTOS GARCEZ, LARISSA
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:DOS SANTOS GARCEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8021
Mailing Address - Country:US
Mailing Address - Phone:631-258-5946
Mailing Address - Fax:
Practice Address - Street 1:659 WILLIS ST
Practice Address - Street 2:
Practice Address - City:SOUTH HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8021
Practice Address - Country:US
Practice Address - Phone:631-258-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker