MEDICARE: MR. CONRAD E. LARKIN L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5501	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104983238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONRAD E. LARKIN L.C.S.W.

Provider Business Mailing Address
First Line	:	422 LARKFIELD CTR
Second Line	:	#255
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1408
Country	:	US
Telephone Number	:	707-566-7570
Fax Number	:	707-312-5659

Provider Business Practice Location Address
First Line	:	924 LANGEBURG ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-2533
Country	:	US
Telephone Number	:	707-566-7570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	12/26/2017

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Directions to “ MR. CONRAD E. LARKIN L.C.S.W.” Practice Location

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