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General NPI Number Information
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NPI Number | 1447472253
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Entity Type | Individual
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Provider Name | GLENN LEWIS FARR LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 791 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1800
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Country | US
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Telephone | 909-824-0480
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 LUCKY ST
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City | OCEANSIDE
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State | CA
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Zip | 92054-5440
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Country | US
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Telephone | 760-439-7618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004748
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25865
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License Number State | CA
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