Provider Demographics
NPI:1356654347
Name:LARSEN, JARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JARY
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 MUIR RD
Mailing Address - Street 2:RESEARCH SERVICE (151)
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4668
Mailing Address - Country:US
Mailing Address - Phone:925-370-4083
Mailing Address - Fax:925-228-5738
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:RESEARCH SERVICE (151)
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-370-4083
Practice Address - Fax:925-228-5738
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15816103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist