Provider Demographics
NPI:1891442687
Name:LARSON, MEGAN JEAN (BA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:LARSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ALLSTON ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2403
Mailing Address - Country:US
Mailing Address - Phone:415-272-7055
Mailing Address - Fax:
Practice Address - Street 1:1 WESTINGHOUSE PLZ STE A216
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-2167
Practice Address - Country:US
Practice Address - Phone:617-910-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor