Provider Demographics
NPI:1437631256
Name:BORCHARD, LARISSA (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:BORCHARD
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HIGGINS AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-8004
Mailing Address - Country:US
Mailing Address - Phone:732-820-0815
Mailing Address - Fax:
Practice Address - Street 1:1540 STATE ROUTE 138 STE 201
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-3765
Practice Address - Country:US
Practice Address - Phone:732-820-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059540001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical