Provider Demographics
NPI:1003078155
Name:LARSON, ROBERT M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:LARSON
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:10000 BAY PINES BLVD
Mailing Address - Street 2:BAY PINES VAHCS
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-398-9567
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:BAY PINES VAHCS
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9567
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0710561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical