Marlena Larson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2512-057 Issued in WI

Practice address

1320 Wisconsin Ave
Racine, WI 53403-1978

Phone

(262) 687-2436

Fax

(262) 687-2495

NPI assigned

Sep 14, 2005

Last updated

Nov 25, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wheaton Franciscan Healthcare-All Saints Foundation Inc

  • General Acute Care Hospital
  • Racine, WI
  • NPI 1528409109
  Authorized official Same address or phone
• Center for Behavioral Medicine, SC

  • Clinical Psychologist
  • Brookfield, WI
  • NPI 1578515417
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1538154679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 4 1/2 MILE RD",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53402",
            "telephone_number": "262-456-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WISCONSIN AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031978",
            "telephone_number": "262-687-2436",
            "fax_number": "262-687-2495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "MARLENA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-14",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2512-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40959700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeview Pharmacy of Racine Inc (Lakeview LTC Pharmacy)
• Lakeview Pharmacy of Racine Inc
• Jacqueline Lamberton, P.T.
• Robert J Lamberton, DDS
• Tyler M Lang, DPT
• Laura Sunn MD SC
• Lauren Murphy Payne and Associates
• Gregory Lautz, LPC
• Roxanne Noelle Le Beau, MA, LPC, CADC
• Ngan T Le

• Clinical Psychologist in Racine, WI
• Providers in Racine, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.