Healthcare Provider Details

I. General information

NPI: 1730659434
Provider Name (Legal Business Name): LARISSA PITRAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 IMPERIAL AVE
BENNINGTON VT
05201-2440
US

IV. Provider business mailing address

120 IMPERIAL AVE
BENNINGTON VT
05201-2440
US

V. Phone/Fax

Practice location:
  • Phone: 321-616-9772
  • Fax:
Mailing address:
  • Phone: 321-616-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001964
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number004814
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80363
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number146.0134444
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: