Provider Demographics
NPI:1295093987
Name:LARSEN, SARAH (LICSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LARSEN
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 1:3 BRUSSELS STREET
Mailing Address - Street 2:SUITE 312
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2903
Mailing Address - Country:US
Mailing Address - Phone:508-656-7761
Mailing Address - Fax:978-415-0067
Practice Address - Street 1:3 BRUSSELS STREET
Practice Address - Street 2:SUITE 312
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2903
Practice Address - Country:US
Practice Address - Phone:508-656-7761
Practice Address - Fax:978-415-0067
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1192721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid