Provider Demographics
NPI:1013322692
Name:ADLER, LARISSA (MA)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:ADLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8838 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3302
Mailing Address - Country:US
Mailing Address - Phone:310-247-0534
Mailing Address - Fax:310-550-8381
Practice Address - Street 1:8838 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3302
Practice Address - Country:US
Practice Address - Phone:310-247-0534
Practice Address - Fax:310-550-8381
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist