Healthcare Provider Details

I. General information

NPI: 1265096416
Provider Name (Legal Business Name): JOANNA LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WASHINGTON ST STE P55
NORWELL MA
02061-1742
US

IV. Provider business mailing address

200 CORDWAINER DR STE 304
NORWELL MA
02061-1671
US

V. Phone/Fax

Practice location:
  • Phone: 781-290-3886
  • Fax:
Mailing address:
  • Phone: 781-546-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW154542
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: