Provider Demographics
NPI:1306905070
Name:GOLD, LARRIE HOWARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:LARRIE
Middle Name:HOWARD
Last Name:GOLD
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 1:108 CRESTVIEW PL
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1604
Mailing Address - Country:US
Mailing Address - Phone:914-674-0409
Mailing Address - Fax:914-674-8458
Practice Address - Street 1:108 CRESTVIEW PL
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1604
Practice Address - Country:US
Practice Address - Phone:914-674-0409
Practice Address - Fax:914-674-8458
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR245231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical