MEDICARE: SARA FARWELL ED.S.

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	103TS0200X	School Psychologist		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	081300157	OTHER	VA	BOARD OF PSYCHOLOGY DEPARTMENT OF HEALTH PROFESSIONS

General Provider Information

NPI Number	:	1790433258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA FARWELL ED.S.

Provider Business Mailing Address
First Line	:	451 CARRIAGE RD.
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 ROUND HILL DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8855
Country	:	US
Telephone Number	:	757-648-2538
Fax Number	:

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

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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Directions to “ SARA FARWELL ED.S.” Practice Location

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