Provider Demographics
NPI:1619314101
Name:LAROSA, VANETTA (BCBA-D)
Entity type:Individual
Prefix:
First Name:VANETTA
Middle Name:
Last Name:LAROSA
Suffix:
Gender:
Credentials:BCBA-D
Other - Prefix:
Other - First Name:VANETTA
Other - Middle Name:
Other - Last Name:DESANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:REAR BUILDING
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7400
Mailing Address - Country:US
Mailing Address - Phone:631-659-3337
Mailing Address - Fax:631-659-3338
Practice Address - Street 1:315 W 57TH ST STE 401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3147
Practice Address - Country:US
Practice Address - Phone:516-659-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026443103G00000X, 103T00000X, 103TB0200X, 103TM1800X
NY1-03-1115103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities