| Doctor Name: | LARISSA F PETILLO |
| NPI Number: | 1477869865 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 44SC05537000 |
| Business Practice Address: | 4326 Us Hwy 1 North Monmouth Junction, NJ - 08852 |
| Business Phone Number: | 7322355790 |
| Business Fax Number: | |
| Mailing Address: | 671 Hoes Ln W, PISCATAWAY |
| State: | NJ |
| Postal Code: | 088548021 |
| Phone Number: | 7322353289 |
| Fax Number: | 7322352101 |
| NPI Enumeration Date: | 08/24/2010 |
| NPI Last Update Date: | 04/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC05537000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |