Provider Demographics
NPI:1477381788
Name:LARISON, DANIELA NICOLETA (MSW, TCADC)
Entity type:Individual
Prefix:MRS
First Name:DANIELA
Middle Name:NICOLETA
Last Name:LARISON
Suffix:
Gender:F
Credentials:MSW, TCADC
Other - Prefix:MS
Other - First Name:DANIELA
Other - Middle Name:NICOLETA
Other - Last Name:MIRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3369
Mailing Address - Country:US
Mailing Address - Phone:859-444-4499
Mailing Address - Fax:859-261-2528
Practice Address - Street 1:1450 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3369
Practice Address - Country:US
Practice Address - Phone:859-444-4499
Practice Address - Fax:859-261-2528
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)