Provider Demographics
NPI:1790890044
Name:LARKIN, DAVID SEYMOUR (LCPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SEYMOUR
Last Name:LARKIN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0044
Mailing Address - Country:US
Mailing Address - Phone:207-702-7858
Mailing Address - Fax:207-474-9096
Practice Address - Street 1:46 FAIRVIEW AVE
Practice Address - Street 2:SUITE NUMBER 334
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1481
Practice Address - Country:US
Practice Address - Phone:207-702-7858
Practice Address - Fax:207-474-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432011899Medicaid