| Larissa Humiston, Lcsw | |
|
1414 Gay Rd Ste 205 Winter Park FL 32789-2928 | |
| (407) 415-1175 | |
| Not Available |
| Full Name | Larissa Humiston, Lcsw |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1414 Gay Rd Ste 205, Winter Park, Florida |
| Authorized Official Name and Position | Larissa K Humiston (OWNER) |
| Authorized Official Contact | 4074151175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larissa Humiston, Lcsw 1414 Gay Rd Ste 205 Winter Park FL 32789-2928 Ph: (407) 415-1175 | Larissa Humiston, Lcsw 1414 Gay Rd Ste 205 Winter Park FL 32789-2928 Ph: (407) 415-1175 |
| NPI Number | 1962976647 |
|---|---|
| Provider Enumeration Date | 01/16/2019 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962976647 | NPI | - | NPPES |
| 1538478714 | Other | INSURANCE PANELS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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