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General NPI Number Information
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NPI Number | 1588207005
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Entity Type | Organization
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Legal Business Name | DANA FARR PHD LLC
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 7 RIVER ST
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City | COLLINSVILLE
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State | CT
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Zip | 06019-3156
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Country | US
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Telephone | 860-841-8414
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SILHOUETTE DR
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City | COLEBROOK
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State | CT
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Zip | 06021-1123
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Country | US
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Telephone | 203-464-3332
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DANA FARR
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Credential | PHD
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Telephone | 203-464-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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