Provider Demographics
NPI:1932526092
Name:REARDEN, LARIN LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:LARIN
Middle Name:LYNN
Last Name:REARDEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:LARIN
Other - Middle Name:LYNN
Other - Last Name:CRAWFORD-BARHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-4858
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:10777 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8130
Practice Address - Country:US
Practice Address - Phone:740-302-0541
Practice Address - Fax:740-886-0255
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1451233104100000X
KY01092014104100000X
OHI1700255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1932526092Medicaid
OH0225208Medicaid
KY7100460900Medicaid