Provider Demographics
NPI:1407089675
Name:LARSEN, ANITA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3357
Mailing Address - Country:US
Mailing Address - Phone:320-632-2003
Mailing Address - Fax:
Practice Address - Street 1:300 6TH ST SW
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-1543
Practice Address - Country:US
Practice Address - Phone:320-616-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical