Healthcare Provider Details

I. General information

NPI: 1063344851
Provider Name (Legal Business Name): LARA MARIE FERRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 WESTCHESTER AVE
BRONX NY
10455-1795
US

IV. Provider business mailing address

65 MORROW AVE
SCARSDALE NY
10583-4623
US

V. Phone/Fax

Practice location:
  • Phone: 718-742-8550
  • Fax:
Mailing address:
  • Phone: 914-574-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: