Healthcare Provider Details

I. General information

NPI: 1164331062
Provider Name (Legal Business Name): ANDREW MICHAEL LARO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MADISON AVE RM 1501
NEW YORK NY
10016-0701
US

IV. Provider business mailing address

274 MADISON AVE RM 1501
NEW YORK NY
10016-0701
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-1773
  • Fax:
Mailing address:
  • Phone: 212-203-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07534800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: