Provider Demographics
NPI:1235802240
Name:LAYH, LARISA
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:LAYH
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 1:49 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6328
Mailing Address - Country:US
Mailing Address - Phone:631-624-6364
Mailing Address - Fax:
Practice Address - Street 1:49 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6328
Practice Address - Country:US
Practice Address - Phone:631-624-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency