MEDICARE: WYNTER LARSON

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	100575-01	NY

General Provider Information

NPI Number	:	1124976923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYNTER LARSON

Provider Business Mailing Address
First Line	:	478 CLASSON AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2555
Country	:	US
Telephone Number	:	914-629-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	478 CLASSON AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2555
Country	:	US
Telephone Number	:	914-629-7185
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ WYNTER LARSON ” Practice Location

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