MEDICARE: LA-TOYA V LARKE LMSW

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	104100000X	Social Worker	CW023795	PA

General Provider Information

NPI Number	:	1760188080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA-TOYA V LARKE LMSW

Provider Business Mailing Address
First Line	:	PO BOX 1379
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-5579
Country	:	US
Telephone Number	:	267-917-0334
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 LILLIAN AVE
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-4334
Country	:	US
Telephone Number	:	267-917-0334
Fax Number	:

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

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	07/30/2024

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