MEDICARE: MR. CUB JOSEPH LARKIN M.S., NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH20066	FL

General Provider Information

NPI Number	:	1083211049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CUB JOSEPH LARKIN M.S., NCC

Provider Business Mailing Address
First Line	:	800 NW 29TH CT
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-2436
Country	:	US
Telephone Number	:	954-892-5552
Fax Number	:	954-405-8948

Provider Business Practice Location Address
First Line	:	800 NW 29TH CT
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-2436
Country	:	US
Telephone Number	:	954-892-5552
Fax Number	:	954-405-8948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	07/05/2022

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