Healthcare Provider Details

I. General information

NPI: 1992796932
Provider Name (Legal Business Name): ROSE M. FARRAR LISW-S/ LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 EL CAMINO DR.
SPRINGFIELD OH
45503-1318
US

IV. Provider business mailing address

3160 EL CAMINO DR.
SPRINGFIELD OH
45503-1318
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-9030
  • Fax: 937-390-9039
Mailing address:
  • Phone: 937-342-9030
  • Fax: 937-390-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0007170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: