Individual
MARY V LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
100 CHARLES EWING BLVD, EWING, NJ 08628-3454
(860) 788-6404
Mailing address
PO BOX 1595, MIDDLETOWN, CT 06457-8095
(860) 788-6404
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
35SI00319100
NJ
Other
Enumeration date
11/02/2006
Last updated
05/31/2024
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