Active NPI
Larissa Ellen Golloub, LCSW-R
- Clinical Social Worker
- Brooklyn, NY
National Provider Identifier
1942352034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R050308-1
- Practice address
- 2581 Atlantic Ave
2ND Floor
Brooklyn, NY 11207-2412 - Phone
- (718) 890-8100
- Fax
- (718) 495-8298
- NPI assigned
- Jan 17, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R050308-1 | NY | Primary |
Addresses
Primary practice location
2581 Atlantic Ave
2ND Floor
Brooklyn, NY 11207-2412
Mailing address
11115 75TH Ave
Apt. 5M
Forest Hills, NY 11375-6327
Phone (718) 890-8100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 29, 2021 through Dec 29, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R050308-1 | NY | MD | Clinical Social Worker |
| 050308 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942352034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11115 75TH AVE",
"address_2": "APT. 5M",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113756327",
"telephone_number": "718-890-8100",
"fax_number": "718-495-8298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2581 ATLANTIC AVE",
"address_2": "2ND FLOOR",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112072412",
"telephone_number": "718-890-8100",
"fax_number": "718-495-8298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLLOUB",
"first_name": "LARISSA",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R050308-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.