Provider Demographics
NPI:1104983238
Name:LARKIN, CONRAD E (LCSW)
Entity type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:E
Last Name:LARKIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 LARKFIELD CTR
Mailing Address - Street 2:#255
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1408
Mailing Address - Country:US
Mailing Address - Phone:707-566-7570
Mailing Address - Fax:707-312-5659
Practice Address - Street 1:924 LANGEBURG ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-2533
Practice Address - Country:US
Practice Address - Phone:707-566-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW055010Medicaid
CAZZZ26181ZMedicare ID - Type UnspecifiedLCSW