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General NPI Number Information
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NPI Number | 1497335582
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Entity Type | Individual
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Provider Name | EMMETT LARSEN PHD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1790 BROADWAY FL 6
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City | NEW YORK
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State | NY
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Zip | 10019-1412
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Country | US
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Telephone | 212-326-8441
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Fax |
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Provider Business Mailing Address
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Address Line | 497 SAINT MARKS AVE APT 4C
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City | BROOKLYN
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State | NY
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Zip | 11238-5791
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Country | US
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Telephone | 646-502-5091
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 027762
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License Number State | NY
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