Provider Demographics
NPI:1689761173
Name:DEGRAFFENREID, LARISA PEREZ (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:PEREZ
Last Name:DEGRAFFENREID
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 1:2505 FOXCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3707
Mailing Address - Country:US
Mailing Address - Phone:703-264-5983
Mailing Address - Fax:703-425-9206
Practice Address - Street 1:2505 FOXCROFT WAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3707
Practice Address - Country:US
Practice Address - Phone:703-264-5983
Practice Address - Fax:703-425-9206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical