Provider Demographics
NPI:1063680080
Name:LARKIN, PETER S (MA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:S
Last Name:LARKIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 COLECHESTER LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9000
Mailing Address - Country:US
Mailing Address - Phone:386-445-4236
Mailing Address - Fax:
Practice Address - Street 1:126 COLECHESTER LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9000
Practice Address - Country:US
Practice Address - Phone:386-445-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 410103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool