Provider Demographics
NPI:1255177846
Name:CARDEN, LARYSSA (LCSW)
Entity type:Individual
Prefix:
First Name:LARYSSA
Middle Name:
Last Name:CARDEN
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 1:1120 LITTLE BAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-1207
Mailing Address - Country:US
Mailing Address - Phone:208-921-2344
Mailing Address - Fax:
Practice Address - Street 1:1120 LITTLE BAY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-1207
Practice Address - Country:US
Practice Address - Phone:757-231-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040170551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical