Healthcare Provider Details

I. General information

NPI: 1164621348
Provider Name (Legal Business Name): CARON ELIZABETH FARRELL M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 MILLS AVE SETON MIND INSTITUTE
AUSTIN TX
78731-6309
US

IV. Provider business mailing address

1601 RIO GRANDE ST SUITE 340
AUSTIN TX
78701-1137
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9999
  • Fax: 512-324-2084
Mailing address:
  • Phone: 512-324-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN5048
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberN5048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: