Healthcare Provider Details

I. General information

NPI: 1659617470
Provider Name (Legal Business Name): RHIANNE K. LARSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 W 242ND ST APT 4C
BRONX NY
10471-4012
US

IV. Provider business mailing address

248 WEST 108TH STREET THE BRIDGE, INC.
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 917-912-2096
  • Fax:
Mailing address:
  • Phone: 212-663-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: