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General NPI Number Information
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NPI Number | 1467747956
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Entity Type | Organization
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Legal Business Name | BRENDA L. FARSIDE LCSW LLC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 3519 SILVERSIDE RD RIDGELY BLDG, SUITE 101B
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City | WILMINGTON
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State | DE
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Zip | 19810-4909
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Country | US
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Telephone | 302-438-2796
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Fax |
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Provider Business Mailing Address
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Address Line | 3519 SILVERSIDE RD RIDGELY BLDG, SUITE 101B
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City | WILMINGTON
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State | DE
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Zip | 19810-4909
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Country | US
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Telephone | 302-438-2796
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. BRENDA LYNN FARSIDE
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Credential | LCSW
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Telephone | 302-438-2796
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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 | Q1-0000612
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License Number State | DE
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