Provider Demographics
NPI:1356698211
Name:LARKIN, RAYCHELL LIZA (MSED)
Entity type:Individual
Prefix:MS
First Name:RAYCHELL
Middle Name:LIZA
Last Name:LARKIN
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 1:1223 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4809
Mailing Address - Country:US
Mailing Address - Phone:718-258-6768
Mailing Address - Fax:
Practice Address - Street 1:1223 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4809
Practice Address - Country:US
Practice Address - Phone:718-258-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391975101174400000X
NY391974101174400000X
NY391973101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist