Healthcare Provider Details

I. General information

NPI: 1871857524
Provider Name (Legal Business Name): CARMEN FARRO GEHRKE LPC, LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 VILLAGE SQUARE XING STE 109
PALM BEACH GARDENS FL
33410-4540
US

IV. Provider business mailing address

342 CARAVELLE DR
JUPITER FL
33458-8207
US

V. Phone/Fax

Practice location:
  • Phone: 561-602-0833
  • Fax: 561-656-2099
Mailing address:
  • Phone: 651-602-0833
  • Fax: 561-656-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006378
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-0000618
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: