Individual
LARISSA LERTOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
8609 W BRYN MAWR AVE STE 204, CHICAGO, IL 60631-3524
(773) 726-1416
Mailing address
44225 W 12 MILE RD STE C-106, NOVI, MI 48377-2640
(248) 277-3005
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401002764
MI
103K00000X
Behavior Analyst
—
—
156F00000X
Technician/Technologist
—
—
Other
Enumeration date
05/09/2018
Last updated
04/07/2025
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