| Doctor Name: | DR. KENNETH A LARSEN |
| NPI Number: | 1053343707 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMIN, PHD, ABMP |
| License Number: | 2944 |
| Business Practice Address: | 125 Parker Hill Ave Roxbury Crossing, MA - 021202847 |
| Business Phone Number: | 6177545160 |
| Business Fax Number: | 6177505444 |
| Mailing Address: | 162 Dodge Rd, ROWLEY |
| State: | MA |
| Postal Code: | 019692211 |
| Phone Number: | 6174132328 |
| Fax Number: | 6177545444 |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 09/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2944 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |