Provider Demographics
NPI:1619314101
Name:LAROSA, VANETTA (BCBA-D)
Entity Type:Individual
Prefix:
First Name:VANETTA
Middle Name:
Last Name:LAROSA
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:VANETTA
Other - Middle Name:
Other - Last Name:DESANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:REAR BUILDING
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7400
Mailing Address - Country:US
Mailing Address - Phone:631-659-3337
Mailing Address - Fax:631-659-3338
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:REAR BUILDING
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7400
Practice Address - Country:US
Practice Address - Phone:631-659-3337
Practice Address - Fax:631-659-3338
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-03-1115103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst