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General NPI Number Information
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NPI Number | 1891116000
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Entity Type | Individual
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Provider Name | AUDREY MARTIN FARRIS LISW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 3461 MARKET ST STE 104
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City | CAMP HILL
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State | PA
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Zip | 17011-4412
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Country | US
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Telephone | 717-219-3986
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Fax |
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Provider Business Mailing Address
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Address Line | 3461 MARKET ST STE 104
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City | CAMP HILL
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State | PA
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Zip | 17011-4412
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Country | US
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Telephone | 717-219-3986
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW128939
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1.1801370
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CW018374
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License Number State | PA
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