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General NPI Number Information
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NPI Number | 1194115188
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Entity Type | Individual
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Provider Name | JAMES SHEPPARD LARGENT LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 2558 ROOSEVELT ST STE 304
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City | CARLSBAD
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State | CA
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Zip | 92008-1672
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Country | US
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Telephone | 760-579-8524
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Fax | 760-237-2292
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Provider Business Mailing Address
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Address Line | 1386 EVERGREEN DR
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City | CARDIFF BY THE SEA
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State | CA
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Zip | 92007-1037
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Country | US
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Telephone | 760-579-8524
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Fax | 760-237-2292
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 64560
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License Number State | CA
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