Provider Demographics
NPI:1730455056
Name:SEYMOUR, LARISSA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2717
Mailing Address - Country:US
Mailing Address - Phone:201-233-7755
Mailing Address - Fax:
Practice Address - Street 1:14 N DEAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2835
Practice Address - Country:US
Practice Address - Phone:201-561-8544
Practice Address - Fax:201-567-7105
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056029001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical