Healthcare Provider Details

I. General information

NPI: 1699248252
Provider Name (Legal Business Name): ENID ELIZABETH LARSEN MSW, PHD, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 DODGE RD
ROWLEY MA
01969-2211
US

IV. Provider business mailing address

162 DODGE RD
ROWLEY MA
01969-2211
US

V. Phone/Fax

Practice location:
  • Phone: 978-835-9013
  • Fax: 978-232-3000
Mailing address:
  • Phone: 978-835-9013
  • Fax: 978-232-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102287
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: