Healthcare Provider Details

I. General information

NPI: 1447472253
Provider Name (Legal Business Name): GLENN LEWIS FARR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 BEECH AVE STE B
CARLSBAD CA
92008-1657
US

IV. Provider business mailing address

580 BEECH AVE STE B
CARLSBAD CA
92008-1657
US

V. Phone/Fax

Practice location:
  • Phone: 442-888-0873
  • Fax:
Mailing address:
  • Phone: 442-888-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: