Provider Demographics
NPI:1740451947
Name:PATACCHIOLA, LARISA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:
Last Name:PATACCHIOLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:DEMSHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, OSW-C
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5450
Mailing Address - Country:US
Mailing Address - Phone:617-582-7576
Mailing Address - Fax:617-632-5603
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5450
Practice Address - Country:US
Practice Address - Phone:617-582-7576
Practice Address - Fax:617-632-5603
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical