Provider Demographics
NPI:1194115188
Name:LARGENT, JAMES SHEPPARD (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SHEPPARD
Last Name:LARGENT
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 1:1386 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1037
Mailing Address - Country:US
Mailing Address - Phone:760-579-8524
Mailing Address - Fax:760-237-2292
Practice Address - Street 1:2558 ROOSEVELT ST STE 304
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1672
Practice Address - Country:US
Practice Address - Phone:760-579-8524
Practice Address - Fax:760-237-2292
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN