Provider Demographics
NPI:1417844366
Name:DURBAK, LARISSA OKSANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:OKSANA
Last Name:DURBAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CLERMONT AVE APT 4U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3320
Mailing Address - Country:US
Mailing Address - Phone:917-482-8298
Mailing Address - Fax:
Practice Address - Street 1:171 CLERMONT AVE APT 4U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3320
Practice Address - Country:US
Practice Address - Phone:917-482-8298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023182103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist