Provider Demographics
NPI:1639228257
Name:KARP, LARRY JACOB (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JACOB
Last Name:KARP
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 1:130 WEST CHURCH
Mailing Address - Street 2:P.O. BOX 202
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0202
Mailing Address - Country:US
Mailing Address - Phone:802-472-6734
Mailing Address - Fax:802-441-1010
Practice Address - Street 1:130 WEST CHURCH
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-0202
Practice Address - Country:US
Practice Address - Phone:802-472-6734
Practice Address - Fax:802-441-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2069395OtherCIGNA
VT206603OtherMBC
VT320598OtherMAGELLAN
VT00018070OtherBLUE CROSS BLUE SHIELD
VT073074OtherVALUE OPTIONS
VT991063OtherMVP
VT1003411Medicaid
VTP00233738OtherMEDICARE RR
VT206603OtherMBC