Healthcare Provider Details

I. General information

NPI: 1750647038
Provider Name (Legal Business Name): LINDSAY GAIL LARRIS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LINCOLN HWY STE 4A
EDISON NJ
08820-3964
US

IV. Provider business mailing address

5 LINCOLN HWY STE 4A
EDISON NJ
08820-3964
US

V. Phone/Fax

Practice location:
  • Phone: 877-759-5017
  • Fax:
Mailing address:
  • Phone: 732-285-9987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05699800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: