Individual
GREGORY RICHARD LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
333 ESTUDILLO AVE, #207, SAN LEANDRO, CA 94577-4717
(510) 541-2983
Mailing address
785 BATES AVE, EL CERRITO, CA 94530-2706
(510) 541-2983
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY11781
CA
Other
Enumeration date
05/16/2007
Last updated
07/09/2007
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