Provider Demographics
NPI:1215127014
Name:FARBER, KACEY (LMSW)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:FARBER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BROADWAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:AMITTYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-691-5011
Mailing Address - Fax:
Practice Address - Street 1:77 BROADWAY
Practice Address - Street 2:SUITE 7
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2785
Practice Address - Country:US
Practice Address - Phone:631-691-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker