Provider Demographics
NPI:1730848151
Name:BAXTER, LARRY THOMAS
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:THOMAS
Last Name:BAXTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S COUNTY COMMONS WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:401-208-0563
Practice Address - Street 1:35 S COUNTY COMMONS WAY FL 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-8240
Practice Address - Country:US
Practice Address - Phone:415-971-2246
Practice Address - Fax:401-208-0563
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical