Provider Demographics
NPI:1659617470
Name:LARSON, RHIANNE K (LCSW)
Entity Type:Individual
Prefix:
First Name:RHIANNE
Middle Name:K
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 WEST 108TH STREET
Mailing Address - Street 2:THE BRIDGE, INC.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-663-3000
Mailing Address - Fax:
Practice Address - Street 1:226 W 242ND ST
Practice Address - Street 2:APT 4C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-4012
Practice Address - Country:US
Practice Address - Phone:917-912-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0734451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical