Andrew John Larsen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

405 Edgewood Dr
Providence, UT 84332-9471

Phone

(435) 233-4417

NPI assigned

Nov 3, 2017

Last updated

Jan 10, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1720590383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 EDGEWOOD DR",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329471",
            "telephone_number": "435-233-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 EDGEWOOD DR",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329471",
            "telephone_number": "435-233-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-03",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10834398-3501",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8760003008007",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "000055266",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260022408",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Jean Lacy, LCSW
• Sierra Trinity Ladnier, DC
• Naomi Landry, PA-C
• Lars Bergeson, M.D., PC
• Lars Bergeson, MD, PC
• Abigail Marie Leavitt, RBT
• Chloe Lewis, RBT
• Bobbie Liechty, M.A., CCC-SLP
• Little Squirts Therapy Services LLC
• Trajan Littlefield

• Clinical Social Worker in Providence, UT
• Providers in Providence, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.