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Individual
ANDREW JOHN LARSEN
Active
Individual
ANDREW JOHN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
10834398-3501
UT
1041C0700X
Clinical Social Worker
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
11/03/2017
Last updated
01/10/2024
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