Healthcare Provider Details

I. General information

NPI: 1205217932
Provider Name (Legal Business Name): TIMOTHY LARKIN JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 WASHINGTON ST
WATERTOWN NY
13601-9371
US

IV. Provider business mailing address

1575 WASHINGTON ST
WATERTOWN NY
13601-9371
US

V. Phone/Fax

Practice location:
  • Phone: 315-779-5060
  • Fax: 315-779-5028
Mailing address:
  • Phone: 315-779-5060
  • Fax: 315-779-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: