MEDICARE: MR. LARRY ANTONIO WOODLAND LCSW

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	075802	NY
2	1041C0700X	Clinical Social Worker	63566	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	:	1164507349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY ANTONIO WOODLAND LCSW

Provider Business Mailing Address
First Line	:	821 S GRAMERCY PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-3449
Country	:	US
Telephone Number	:	510-387-7965
Fax Number	:	213-632-3192

Provider Business Practice Location Address
First Line	:	627 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1307
Country	:	US
Telephone Number	:	510-387-7965
Fax Number	:	213-632-3192

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/21/2023

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