| NPI | 1164875779 |
|---|---|
| Former Name | LARISSA PEYTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 6992) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 10577) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |