Individual
MISS MALISSA ANN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
192 RICHMOND AVE, BUFFALO, NY 14222-2112
(646) 823-5401
Mailing address
192 RICHMOND AVE, BUFFALO, NY 14222-2112
(646) 823-5401
Taxonomy
Speciality
Code
Description
License number
State
103TE1100X
Exercise & Sports Psychologist
—
—
374J00000X
Doula
Primary
—
—
Other
Enumeration date
12/17/2018
Last updated
06/11/2019
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