Healthcare Provider Details

I. General information

NPI: 1255152195
Provider Name (Legal Business Name): JOHN J FARLEY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 THE ALAMEDA
SAN JOSE CA
95126-1131
US

IV. Provider business mailing address

1030 E EL CAMINO REAL # 322
SUNNYVALE CA
94087-3841
US

V. Phone/Fax

Practice location:
  • Phone: 408-688-4596
  • Fax:
Mailing address:
  • Phone: 408-688-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: