MEDICARE: MARCELA FARFAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00653700	NJ

General Provider Information

NPI Number	:	1194297739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELA FARFAN LPC

Provider Business Mailing Address
First Line	:	6411 GRAND AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3525
Country	:	US
Telephone Number	:	954-899-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 GRAND AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3525
Country	:	US
Telephone Number	:	201-898-3109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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