Provider Demographics
NPI:1770880510
Name:LARKIN, MATTHEW A
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:LARKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:301 LOS GATOS SARATOGA RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5327
Mailing Address - Country:US
Mailing Address - Phone:408-399-5677
Mailing Address - Fax:
Practice Address - Street 1:301 LOS GATOS SARATOGA RD STE B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5327
Practice Address - Country:US
Practice Address - Phone:408-399-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist