Provider Demographics
NPI:1508687211
Name:MILLER, LARISSA RACHEL (MSW)
Entity type:Individual
Prefix:MS
First Name:LARISSA
Middle Name:RACHEL
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-4046
Mailing Address - Country:US
Mailing Address - Phone:347-232-1748
Mailing Address - Fax:
Practice Address - Street 1:5 BOCES RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6565
Practice Address - Country:US
Practice Address - Phone:845-486-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker