Provider Demographics
NPI:1609104843
Name:WAINER, LARISA RASHKOVSKY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:RASHKOVSKY
Last Name:WAINER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:RASHKOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:6 MEREDITH CT
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-2106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 E MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2641
Practice Address - Country:US
Practice Address - Phone:973-381-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5033103T00000X
NY19634103T00000X
NJ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty