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General NPI Number Information
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NPI Number | 1184832495
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Entity Type | Individual
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Provider Name | DALE G LARSON PHD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1769 PARK AVE SUITE 210
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City | SAN JOSE
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State | CA
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Zip | 95126-2029
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Country | US
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Telephone | 408-554-4320
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Fax |
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Provider Business Mailing Address
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Address Line | SANTA CLARA UNIVERSITY 500 EL CAMINO REAL
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City | SANTA CLARA
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State | CA
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Zip | 95053-0201
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Country | US
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Telephone | 408-554-4320
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Fax | 408-554-2392
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PA7753
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License Number State | CA
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