A. Brooks Larsen, L.C.S.W.
Individual provider Active NPI Clinical Social Worker · Mayfield, UT
NPI 1720264690 · NPPES record last updated Nov 10, 2022
Key facts
- NPI
- 1720264690
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCS12724 (CA)
- Practice address
- 133 N 100 W
Mayfield, UT 84643-0209 - Phone
- (209) 669-2880
- Fax
- (435) 528-5394
- NPI assigned
- Jan 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS12724 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camille L. Holmes | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS12724 | CA | Yes |
Addresses
Primary practice location
133 N 100 W
Mayfield, UT 84643-0209
Mailing address
PO Box 209
Mayfield, UT 84643-0209
Phone (092) 669-2880
Other names
- Mr. Ashby Brooks Larsen
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.