Provider Demographics
NPI:1225263486
Name:LARSEN, LUCY RICARDO (LAC)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:RICARDO
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TIFFANY LANE
Mailing Address - Street 2:
Mailing Address - City:FABER
Mailing Address - State:VA
Mailing Address - Zip Code:22938
Mailing Address - Country:US
Mailing Address - Phone:434-361-1518
Mailing Address - Fax:
Practice Address - Street 1:202 TURKEYSAG TRAIL
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963
Practice Address - Country:US
Practice Address - Phone:434-591-0900
Practice Address - Fax:866-836-8883
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist