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General NPI Number Information
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NPI Number | 1629679303
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Entity Type | Individual
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Provider Name | KAMARIE LEE LARSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/08/2020
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 2705 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-3047
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Country | US
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Telephone | 850-737-6864
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Fax |
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Provider Business Mailing Address
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Address Line | 210 FIRETHORN RD
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City | GULF BREEZE
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State | FL
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Zip | 32561-4318
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Country | US
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Telephone | 850-737-6864
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10415
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License Number State | FL
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