Healthcare Provider Details

I. General information

NPI: 1932865557
Provider Name (Legal Business Name): CRYSTAL M FARKAS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FOREST AVE
PARAMUS NJ
07652-5429
US

IV. Provider business mailing address

70 SPARTA AVE STE 104
SPARTA NJ
07871-1760
US

V. Phone/Fax

Practice location:
  • Phone: 201-490-5158
  • Fax:
Mailing address:
  • Phone: 862-200-3780
  • Fax: 973-726-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06030700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier44SC06030700
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerBOARD OF SOCIAL WORK EXAMINERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: