MEDICARE: BARRY JOSEPH LARSON

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	1041C0700X	Clinical Social Worker	2025045098	MO

General Provider Information

NPI Number	:	1740141985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY JOSEPH LARSON

Provider Business Mailing Address
First Line	:	3155 SUTTON BLVD STE 201
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-3917
Country	:	US
Telephone Number	:	314-781-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3155 SUTTON BLVD STE 201
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-3917
Country	:	US
Telephone Number	:	314-704-8890
Fax Number	:

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

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	11/18/2025

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Directions to “ BARRY JOSEPH LARSON ” Practice Location

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