Provider Demographics
NPI:1477835304
Name:TORRES, LARISSA (MS)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CONSULATE DR
Mailing Address - Street 2:APT 4C
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2410
Mailing Address - Country:US
Mailing Address - Phone:914-202-8819
Mailing Address - Fax:
Practice Address - Street 1:75 PARK AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-2441
Practice Address - Country:US
Practice Address - Phone:914-934-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist