Provider Demographics
NPI:1467799296
Name:LARA LARSON, LSW, PSYD, LLC
Entity Type:Organization
Organization Name:LARA LARSON, LSW, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, PSYD
Authorized Official - Phone:808-383-8713
Mailing Address - Street 1:500 UNIVERSITY AVE
Mailing Address - Street 2:APT. 136
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4904
Mailing Address - Country:US
Mailing Address - Phone:808-383-8713
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:PH38
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3503
Practice Address - Country:US
Practice Address - Phone:808-383-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1372251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health