Provider Demographics
NPI:1457884173
Name:LARISSA MORLOCK, PHD
Entity Type:Organization
Organization Name:LARISSA MORLOCK, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-281-0068
Mailing Address - Street 1:992 GREAT PLAIN AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2524
Mailing Address - Country:US
Mailing Address - Phone:517-281-0068
Mailing Address - Fax:
Practice Address - Street 1:992 GREAT PLAIN AVE STE 25
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2524
Practice Address - Country:US
Practice Address - Phone:517-281-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9768251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health