MEDICARE: TAMARA FARRIS

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	104100000X	Social Worker	SW138658	PA
2	1041C0700X	Clinical Social Worker	P020224	NC

General Provider Information

NPI Number	:	1619622206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA FARRIS

Provider Business Mailing Address
First Line	:	108F N READING RD # 18671721
Second Line	:
City	:	EPHRATA
State	:	PA
Zip	:	17522-1668
Country	:	US
Telephone Number	:	717-219-5711
Fax Number	:	717-219-5712

Provider Business Practice Location Address
First Line	:	3111 SPRINGBANK LN STE I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:	855-675-4144
Fax Number	:	617-807-0958

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

Provider Enumeration Date	:	02/13/2022
Last Update Date	:	06/19/2025

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Directions to “ TAMARA FARRIS ” Practice Location

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