Provider Demographics
NPI:1821686171
Name:LARSON, PATRICIA MARY (BSL)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:LARSON
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1622
Mailing Address - Country:US
Mailing Address - Phone:412-573-0141
Mailing Address - Fax:412-573-0148
Practice Address - Street 1:4250 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1622
Practice Address - Country:US
Practice Address - Phone:412-573-0141
Practice Address - Fax:412-573-0148
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004275106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst