Provider Demographics
NPI:1811904543
Name:LARIN, JULIA (LCSW, CASAC)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:LARIN
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VARSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1040
Mailing Address - Country:US
Mailing Address - Phone:631-689-5239
Mailing Address - Fax:631-689-5239
Practice Address - Street 1:55 NESCONSET HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2631
Practice Address - Country:US
Practice Address - Phone:631-473-0370
Practice Address - Fax:631-689-5239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8026101YA0400X
NYR033195-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7400907OtherGHI PROVIDER NUMBER
NYP3549311OtherOXFORD PROVIDER NUMBER
NY095319OtherVALUE OPTIONS PROVIDER #
NY23550OtherVYTRA PROVIDER NUMBER
NY83338474OtherMULTIPLAN PROVIDER NUMBER
NYR033195-A37OtherHEALTHFIRST PROVIDER NUMB