Individual
MARK R. LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
130 ALLENS CREEK RD, ROCHESTER, NY 14618-3305
(585) 473-5810
(585) 473-5193
Mailing address
130 ALLENS CREEK RD, ROCHESTER, NY 14618-3305
(585) 473-5810
(585) 473-5193
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
013650
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106063FC
PREFERRED CARE
NY
01
—
7043329
AETNA
NY
01
—
S13650-7W
WORKER'S COMPENSATION
NY
Enumeration date
03/24/2006
Last updated
07/08/2007
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