Provider Demographics
NPI:1023674967
Name:FERNSLER, LARISSA MORGAN (MED)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:MORGAN
Last Name:FERNSLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:MORGAN
Other - Last Name:GLUSZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-4327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1208
Practice Address - Country:US
Practice Address - Phone:570-629-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)