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General NPI Number Information
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NPI Number | 1093409377
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Entity Type | Individual
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Provider Name | LARISSA ANNE DAVIDOWITZ
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Gender | Female
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 400 DOANSBURG RD
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City | BREWSTER
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State | NY
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Zip | 10509-5902
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Country | US
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Telephone | 845-278-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 17 RIVER VIEW LN
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City | WOODBURY
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State | CT
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Zip | 06798-2700
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Country | US
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Telephone | 203-586-9856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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