Provider Demographics
NPI:1194116954
Name:FARABAUGH, JEANNE CATHERINE (MAC)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:CATHERINE
Last Name:FARABAUGH
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 ROUTE 73 N STE B
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1279
Mailing Address - Country:US
Mailing Address - Phone:856-424-4408
Mailing Address - Fax:
Practice Address - Street 1:951 ROUTE 73 N STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1279
Practice Address - Country:US
Practice Address - Phone:856-424-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13444101YP2500X
NJ37PC00713100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional