Provider Demographics
NPI:1619314135
Name:YOSSEFI, LARISSA (NP)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:YOSSEFI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2211
Mailing Address - Country:US
Mailing Address - Phone:347-653-9555
Mailing Address - Fax:
Practice Address - Street 1:195 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2211
Practice Address - Country:US
Practice Address - Phone:347-653-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606294101YA0400X, 163W00000X
NY402174363LP0808X
NYF402174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619314135OtherNPI
NY03008151Medicaid