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General NPI Number Information
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NPI Number | 1831628130
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Entity Type | Individual
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Provider Name | LARISSA BOODHOO LCSW, CASAC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 165 N VILLAGE AVE STE 119
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3701
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Country | US
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Telephone | 516-376-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 CARNATION AVE
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City | BALDWIN
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State | NY
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Zip | 11510-4402
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Country | US
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Telephone | 516-376-2906
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 33740
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 108481
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 097930
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License Number State | NY
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