Healthcare Provider Details

I. General information

NPI: 1447558473
Provider Name (Legal Business Name): LARISSA K RUUSKANEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PRINCESS ANNE ST STE 325
FREDERICKSBURG VA
22401-3358
US

IV. Provider business mailing address

2217 PRINCESS ANNE ST STE 325
FREDERICKSBURG VA
22401-3358
US

V. Phone/Fax

Practice location:
  • Phone: 540-412-8275
  • Fax:
Mailing address:
  • Phone: 540-412-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810003829
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003829
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0810003829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: