Provider Demographics
NPI:1902594385
Name:RANCIER-OTERO, LARISSA JANICE (PSYD)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:JANICE
Last Name:RANCIER-OTERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY # D10-38
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-3512
Mailing Address - Fax:718-334-5006
Practice Address - Street 1:7901 BROADWAY # D10-38
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3512
Practice Address - Fax:718-334-5006
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical