Healthcare Provider Details

I. General information

NPI: 1982178158
Provider Name (Legal Business Name): LARISSA WOLOSZYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD STE 320
ROCKVILLE MD
20850-6280
US

IV. Provider business mailing address

3570 WARRENSVILLE CENTER RD STE 106
SHAKER HEIGHTS OH
44122-5226
US

V. Phone/Fax

Practice location:
  • Phone: 301-882-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: