Individual
MR. PHILIP REED LARSEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW, LCSW
Contact information
Practice address
1229 S SAINT FRANCIS DR STE B, SANTA FE, NM 87505-4052
(413) 626-1094
Mailing address
PO BOX 2139, SANTA CRUZ, NM 87567-2139
(413) 626-1094
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
110336
MA
1041C0700X
Clinical Social Worker
Primary
C-09948
NM
Other
Enumeration date
06/23/2006
Last updated
10/12/2018
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