Provider Demographics
NPI:1619103090
Name:MASON, LARISSA H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LARISSA
Middle Name:H
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:H
Other - Last Name:BOIANELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-226-2164
Mailing Address - Fax:
Practice Address - Street 1:509 WILSON AVENUE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-226-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053927001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical