Provider Demographics
NPI:1649355959
Name:LARRAGUIBEL, MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LARRAGUIBEL
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 1:145 W 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6701
Mailing Address - Country:US
Mailing Address - Phone:212-229-6905
Mailing Address - Fax:646-477-4094
Practice Address - Street 1:145 W 15TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6701
Practice Address - Country:US
Practice Address - Phone:212-229-6905
Practice Address - Fax:646-477-4094
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0726161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426033657OtherFIDELIS
NY040426033657OtherFIDELIS