Provider Demographics
NPI:1376601906
Name:LARSSON, CHRISTER B (PSYD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTER
Middle Name:B
Last Name:LARSSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MEMORIAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4662
Mailing Address - Country:US
Mailing Address - Phone:617-868-0400
Mailing Address - Fax:
Practice Address - Street 1:810 MEMORIAL DR STE 103
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4662
Practice Address - Country:US
Practice Address - Phone:617-868-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY7477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical