Individual
DR. STACEY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
69 BAKER STREET, HOLLISTON, MA 01746
(302) 545-0246
Mailing address
69 BAKER ST, HOLLISTON, MA 01746-1301
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05567
MD
103TF0200X
Forensic Psychologist
05567
MD
Other
Enumeration date
09/28/2017
Last updated
10/10/2017
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