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General NPI Number Information
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NPI Number | 1467799296
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Entity Type | Organization
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Legal Business Name | LARA LARSON, LSW, PSYD, LLC
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 1221 KAPIOLANI BLVD PH38
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City | HONOLULU
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State | HI
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Zip | 96814-3503
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Country | US
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Telephone | 808-383-1785
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Fax |
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Provider Business Mailing Address
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Address Line | 500 UNIVERSITY AVE APT. 136
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City | HONOLULU
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State | HI
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Zip | 96826-4904
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Country | US
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Telephone | 808-383-8713
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LARA LARSON
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Credential | LSW, PSYD
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Telephone | 808-383-8713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY 1372
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License Number State | HI
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