Provider Demographics
NPI:1225754765
Name:EWING, LARKEN SIMONE
Entity Type:Individual
Prefix:
First Name:LARKEN
Middle Name:SIMONE
Last Name:EWING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MARTENSE ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3677
Mailing Address - Country:US
Mailing Address - Phone:845-326-6795
Mailing Address - Fax:
Practice Address - Street 1:223 MARTENSE ST APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3677
Practice Address - Country:US
Practice Address - Phone:845-326-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst