Basic Information
| Provider Information | |||||||||
| NPI: | 1598028193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARBER | ||||||||
| FirstName: | FALLON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P-LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 BROOK ST | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184072141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708405399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1409 PINCKNEY ST | ||||||||
| Address2: | |||||||||
| City: | WHITEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284722220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106410600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P007207 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.