Provider Demographics
NPI:1720488174
Name:LARSEN, NANCY RODRIGUEZ (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RODRIGUEZ
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S MAIN ST # 126
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1851
Mailing Address - Country:US
Mailing Address - Phone:801-623-1996
Mailing Address - Fax:
Practice Address - Street 1:230 EAST 400 SOUTH
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:801-623-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker