=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548291339
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LARKEY PSY D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 01/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 W LAKE MARY BLVD SUITE 218
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-265-1900
-----------------------------------------------------
Fax | 407-788-7271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 PRIMROSE DR
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-4955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-265-1900
-----------------------------------------------------
Fax | 407-788-7271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY5678
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------