Provider Demographics
NPI:1760811376
Name:CORREA, LARISA ANGELICA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LARISA
Middle Name:ANGELICA
Last Name:CORREA
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 1:7800 CARLYLE AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2006
Mailing Address - Country:US
Mailing Address - Phone:347-738-1199
Mailing Address - Fax:800-655-3085
Practice Address - Street 1:400 KINGS POINT DR APT 504
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4733
Practice Address - Country:US
Practice Address - Phone:347-738-1199
Practice Address - Fax:800-644-3085
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW163141041C0700X, 1041C0700X
NY0881791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical