Provider Demographics
NPI:1619115060
Name:TRAGA, LARISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:TRAGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 JAMES WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2879
Mailing Address - Country:US
Mailing Address - Phone:805-266-3231
Mailing Address - Fax:805-262-6275
Practice Address - Street 1:330 JAMES WAY STE 110
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2879
Practice Address - Country:US
Practice Address - Phone:805-266-3231
Practice Address - Fax:805-262-6275
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW617761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical