Provider Demographics
NPI:1750647038
Name:LARRIS, LINDSAY GAIL (LSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:GAIL
Last Name:LARRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6303
Mailing Address - Country:US
Mailing Address - Phone:609-759-7481
Mailing Address - Fax:609-452-0627
Practice Address - Street 1:819 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6303
Practice Address - Country:US
Practice Address - Phone:609-759-7481
Practice Address - Fax:609-452-0627
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05699800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker