Provider Demographics
NPI:1679103519
Name:LARSEN, MIKAL (LCSW)
Entity type:Individual
Prefix:
First Name:MIKAL
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SOUTH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1964
Mailing Address - Country:US
Mailing Address - Phone:860-461-0504
Mailing Address - Fax:860-461-0659
Practice Address - Street 1:97 SOUTH ST STE 105
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1964
Practice Address - Country:US
Practice Address - Phone:860-461-0504
Practice Address - Fax:860-461-0659
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor