Healthcare Provider Details

I. General information

NPI: 1245266188
Provider Name (Legal Business Name): CLAIRE R FARNSWORTH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FRONT ST.
MALTA OH
43758
US

IV. Provider business mailing address

401 FRONT ST. BOX 236
MALTA OH
43758
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-2601
  • Fax: 740-962-2601
Mailing address:
  • Phone: 740-962-2601
  • Fax: 740-962-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: