Active NPI
Larissa Ann Street
- Speech-Language Pathologist
- Cambridge, MD
National Provider Identifier
1457829616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 06716
- Practice address
- 700 Glasgow St
Cambridge, MD 21613-1738 - Phone
- (410) 228-4747
- NPI assigned
- Nov 6, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 06716 | MD | Primary |
Addresses
Primary practice location
700 Glasgow St
Cambridge, MD 21613-1738
Mailing address
26601 Quantico Creek Rd
Hebron, MD 21830-2183
Phone (845) 389-3942
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06716 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541462400000",
"number": "1457829616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26601 QUANTICO CREEK RD",
"city": "HEBRON",
"state": "MD",
"postal_code": "218302183",
"telephone_number": "845-389-3942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 GLASGOW ST",
"city": "CAMBRIDGE",
"state": "MD",
"postal_code": "216131738",
"telephone_number": "410-228-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STREET",
"first_name": "LARISSA",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-06",
"last_updated": "2018-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "06716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.