Healthcare Provider Details

I. General information

NPI: 1225651292
Provider Name (Legal Business Name): PATRICIA L FARRAR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 05/25/2020
Certification Date: 05/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 HARMONY RD
CATAWBA SC
29704-9478
US

IV. Provider business mailing address

3572 HARMONY RD
CATAWBA SC
29704-9478
US

V. Phone/Fax

Practice location:
  • Phone: 267-337-2063
  • Fax:
Mailing address:
  • Phone: 267-337-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3782
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: