Provider Demographics
NPI:1003850330
Name:LARIA, AMARO J (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMARO
Middle Name:J
Last Name:LARIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE TWO EAST
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-608-0061
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:SUITE TWO EAST
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-608-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7454MA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALAW51023Medicare ID - Type Unspecified