=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952850398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOK YIN LARISSA LAI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2016
-----------------------------------------------------
Last Update Date | 09/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 REMSEN ST STE 1201
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-4320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-855-6240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 E 7TH ST APT 22
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10009-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-525-2098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 098475-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------