Provider Demographics
NPI:1275238354
Name:BURRIS, LARINA D (LPMHC)
Entity Type:Individual
Prefix:
First Name:LARINA
Middle Name:D
Last Name:BURRIS
Suffix:
Gender:F
Credentials:LPMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BERGOLD ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4914
Mailing Address - Country:US
Mailing Address - Phone:631-877-7881
Mailing Address - Fax:
Practice Address - Street 1:121 BERGOLD ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4914
Practice Address - Country:US
Practice Address - Phone:631-877-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health