Individual
JILL M LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
124 ROUTE 2A, PRESTON, CT 06365-8537
(612) 232-8367
Mailing address
124 ROUTE 2A, PRESTON, CT 06365-8537
(612) 232-8367
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
009138
CT
1041C0700X
Clinical Social Worker
18215
MD
Other
Enumeration date
09/22/2011
Last updated
11/09/2015
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