Provider Demographics
NPI:1831831809
Name:LARRAZABAL, DANIEL (LSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LARRAZABAL
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ISLAND RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2822
Mailing Address - Country:US
Mailing Address - Phone:973-897-1919
Mailing Address - Fax:
Practice Address - Street 1:545 ISLAND RD STE 2B
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2822
Practice Address - Country:US
Practice Address - Phone:973-897-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1649718685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health