Provider Demographics
NPI:1003678558
Name:LARISA NEBRE, LLC
Entity Type:Organization
Organization Name:LARISA NEBRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:HISAKO
Authorized Official - Last Name:NEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-635-2114
Mailing Address - Street 1:4343 AALONA ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5344
Mailing Address - Country:US
Mailing Address - Phone:808-635-2114
Mailing Address - Fax:
Practice Address - Street 1:4343 AALONA ST
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5344
Practice Address - Country:US
Practice Address - Phone:808-635-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty