Provider Demographics
NPI:1255839783
Name:BERARDINELLI, LARRISA ANNE
Entity Type:Individual
Prefix:
First Name:LARRISA
Middle Name:ANNE
Last Name:BERARDINELLI
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 1:3088 CRANBERRY HWY
Mailing Address - Street 2:
Mailing Address - City:E WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-4800
Mailing Address - Country:US
Mailing Address - Phone:508-295-7990
Mailing Address - Fax:508-295-3781
Practice Address - Street 1:3088 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:E WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4800
Practice Address - Country:US
Practice Address - Phone:508-295-7990
Practice Address - Fax:508-295-3781
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)