Provider Demographics
NPI:1053850313
Name:LAROCCA, KRISTY (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LAROCCA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LIAM DR APT 101
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2249
Mailing Address - Country:US
Mailing Address - Phone:917-268-2520
Mailing Address - Fax:
Practice Address - Street 1:4 LIAM DR APT 101
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2249
Practice Address - Country:US
Practice Address - Phone:917-268-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007726-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health