Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 071056 | NY |
NPI | 1003078155 |
---|---|
Provider Name | Mr. Robert M Larson |
First Address | Bay Pines, FL 33744 |
Second Address | Bay Pines, FL 33744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 28/11/2015 |