Individual
ANDREW JOHN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
405 EDGEWOOD DR, PROVIDENCE, UT 84332-9471
(435) 233-4417
Mailing address
405 EDGEWOOD DR, PROVIDENCE, UT 84332-9471
(435) 233-4417
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
10834398-3501
UT
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
11/03/2017
Last updated
01/10/2024
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