Healthcare Provider Details

I. General information

NPI: 1619314101
Provider Name (Legal Business Name): VANETTA LAROSA BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANETTA DESANTO

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 57TH ST STE 401
NEW YORK NY
10019-3147
US

IV. Provider business mailing address

160 E MAIN ST REAR BUILDING
HUNTINGTON NY
11743-7400
US

V. Phone/Fax

Practice location:
  • Phone: 516-659-5041
  • Fax:
Mailing address:
  • Phone: 631-659-3337
  • Fax: 631-659-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number026443
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number026443
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number026443
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number026443
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: