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General NPI Number Information
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NPI Number | 1699925990
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Entity Type | Individual
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Provider Name | KRISTA JANE LARSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 220 5TH AVE FL 11
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City | NEW YORK
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State | NY
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Zip | 10001-8017
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Country | US
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Telephone | 646-722-6802
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E 25TH ST APT 6C
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City | NEW YORK
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State | NY
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Zip | 10010-3130
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Country | US
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Telephone | 646-733-6802
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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 | 077006
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05963100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0790921
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 079092
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License Number State | NY
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