MEDICARE: DR. BONNIE J FARR PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY 7147	FL
2	103TC0700X	Clinical Psychologist	PY 7147	FL

General Provider Information

NPI Number	:	1609008465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE J FARR PSYD

Provider Business Mailing Address
First Line	:	3002 SE 1ST AVE
Second Line	:	BUILDING 200
City	:	OCALA
State	:	FL
Zip	:	34471-0477
Country	:	US
Telephone Number	:	352-209-8649
Fax Number	:	352-486-7884

Provider Business Practice Location Address
First Line	:	3002 SE 1ST AVE
Second Line	:	BUILDING 200
City	:	OCALA
State	:	FL
Zip	:	34471-0477
Country	:	US
Telephone Number	:	352-209-8649
Fax Number	:	352-486-7884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	11/20/2014

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