Provider Demographics
NPI:1871909002
Name:ASHEROVA, LARISA
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:ASHEROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8374 TALBOT ST
Mailing Address - Street 2:#4E
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3539
Mailing Address - Country:US
Mailing Address - Phone:917-407-8285
Mailing Address - Fax:
Practice Address - Street 1:8374 TALBOT ST
Practice Address - Street 2:#4E
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3539
Practice Address - Country:US
Practice Address - Phone:917-407-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor