MEDICARE: CORNELIA FARR

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	103K00000X	Behavior Analyst	2266-C	NV
2	1041C0700X	Clinical Social Worker	2266-C	NV

General Provider Information

NPI Number	:	1215208558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORNELIA FARR

Provider Business Mailing Address
First Line	:	5130 VINCITOR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3223
Country	:	US
Telephone Number	:	702-255-2916
Fax Number	:	702-255-2916

Provider Business Practice Location Address
First Line	:	5130 VINCITOR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3223
Country	:	US
Telephone Number	:	702-255-2916
Fax Number	:	702-255-2916

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

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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Directions to “ CORNELIA FARR ” Practice Location

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