Provider Demographics
NPI:1770002248
Name:NIERENBERG, LARISSA (MSED)
Entity Type:Individual
Prefix:MISS
First Name:LARISSA
Middle Name:
Last Name:NIERENBERG
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1143
Mailing Address - Country:US
Mailing Address - Phone:631-589-8060
Mailing Address - Fax:631-589-0908
Practice Address - Street 1:335 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1143
Practice Address - Country:US
Practice Address - Phone:631-589-8060
Practice Address - Fax:631-589-0908
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator