Provider Demographics
NPI:1215302716
Name:LARSON, REBECCA SUTTON (LCSW-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUTTON
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 PULASKI HWY
Mailing Address - Street 2:STE 4
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3744
Mailing Address - Country:US
Mailing Address - Phone:443-877-4044
Mailing Address - Fax:443-967-0077
Practice Address - Street 1:111 W HIGH ST STE 204
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-8611
Practice Address - Country:US
Practice Address - Phone:410-620-0008
Practice Address - Fax:410-620-1999
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical