Provider Demographics
NPI:1497335582
Name:LARSEN, EMMETT (MA)
Entity Type:Individual
Prefix:
First Name:EMMETT
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 PROSPECT PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-8000
Mailing Address - Country:US
Mailing Address - Phone:920-941-0238
Mailing Address - Fax:
Practice Address - Street 1:1790 BROADWAY FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1412
Practice Address - Country:US
Practice Address - Phone:212-326-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor