Basic Information
| Provider Information | |||||||||
| NPI: | 1407442114 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARROW | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LAMARR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 RUSS ST APT 5 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061061556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027960089 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 STATE ST | ||||||||
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| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064503293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032372229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2020 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.