| Doctor Name: | DR. LARISA SURENOVNA DZHAVAKOVA |
| NPI Number: | 1003070319 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 1701 A Grant Ave Philadelphia, PA - 191153160 |
| Business Phone Number: | 2154643838 |
| Business Fax Number: | 2154643899 |
| Mailing Address: | 1701 A Grant Ave, PHILADELPHIA |
| State: | PA |
| Postal Code: | 191153160 |
| Phone Number: | 2154643838 |
| Fax Number: | 2154643899 |
| NPI Enumeration Date: | 07/16/2008 |
| NPI Last Update Date: | 07/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |