Provider Demographics
NPI:1548285380
Name:LARSON, RITA W (PHD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:W
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAN ANTONIO CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1254
Mailing Address - Country:US
Mailing Address - Phone:650-941-2212
Mailing Address - Fax:650-965-2820
Practice Address - Street 1:201 SAN ANTONIO CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1254
Practice Address - Country:US
Practice Address - Phone:650-941-2212
Practice Address - Fax:650-965-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL59390Medicare ID - Type Unspecified