Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34000665A | IN |
NPI | 1003161027 |
---|---|
Provider Name | Mrs. Susan Glassburn Larimer |
First Address | Carmel, IN 46032-5317 |
Second Address | Carmel, IN 46032-5317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 16/07/2012 |