Provider Demographics
NPI:1083846851
Name:LAROSE, DARLENE SIMONE (CNA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:SIMONE
Last Name:LAROSE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1029
Mailing Address - Country:US
Mailing Address - Phone:917-447-6211
Mailing Address - Fax:
Practice Address - Street 1:4517 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1029
Practice Address - Country:US
Practice Address - Phone:917-447-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337464840190E251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY263669425Medicaid