Provider Demographics
NPI:1376025031
Name:LARISSA CORDEIRA PSYD LLC
Entity Type:Organization
Organization Name:LARISSA CORDEIRA PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-721-7481
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-0566
Mailing Address - Country:US
Mailing Address - Phone:808-721-7481
Mailing Address - Fax:808-888-0550
Practice Address - Street 1:66-590 KAMEHAMEHA HWY STE 2G
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1484
Practice Address - Country:US
Practice Address - Phone:808-721-7481
Practice Address - Fax:808-888-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1713251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health