Provider Demographics
NPI:1932726460
Name:HALL RAMOS, LARISSA HEMA (LCAT, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:HEMA
Last Name:HALL RAMOS
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ROOSEVELT AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1106
Mailing Address - Country:US
Mailing Address - Phone:631-533-4487
Mailing Address - Fax:
Practice Address - Street 1:42 GUY LOMBARDO AVE RM 209
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3610
Practice Address - Country:US
Practice Address - Phone:631-533-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001308221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist