Healthcare Provider Details

I. General information

NPI: 1306845318
Provider Name (Legal Business Name): LYNDA TOMALONIS FARRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUSH RIVER RT. 460
FARMVILLE VA
23901
US

IV. Provider business mailing address

PO BOX 248
FARMVILLE VA
23901-0248
US

V. Phone/Fax

Practice location:
  • Phone: 434-392-3187
  • Fax: 434-392-5789
Mailing address:
  • Phone: 434-392-3187
  • Fax: 434-392-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001963
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: