1538177035 NPI number — MARGARET CAMILLE LARSON LICSW

Table of content: MARGARET CAMILLE LARSON LICSW (NPI 1538177035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538177035 NPI number — MARGARET CAMILLE LARSON LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSON
Provider First Name:
MARGARET
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538177035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BLOOMINGTON AVE S
Provider Second Line Business Mailing Address:
COMMUNITY-UNIVERSITY HEALTH CARE CENTER
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404-3074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-638-0700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 BLOOMINGTON AVE S
Provider Second Line Business Practice Location Address:
COMMUNITY-UNIVERSITY HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-638-0700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)