Provider Demographics
NPI:1831301209
Name:LARSON, CHERYL ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 GANNETT RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1206
Mailing Address - Country:US
Mailing Address - Phone:781-545-3182
Mailing Address - Fax:
Practice Address - Street 1:51 MILL ST
Practice Address - Street 2:SUITE # 8
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1641
Practice Address - Country:US
Practice Address - Phone:781-956-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical