Provider Demographics
NPI:1275329252
Name:CHOUDRY, FARYAL (LCSW)
Entity type:Individual
Prefix:
First Name:FARYAL
Middle Name:
Last Name:CHOUDRY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13158 ODYSSEY LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4642
Mailing Address - Country:US
Mailing Address - Phone:352-630-8626
Mailing Address - Fax:
Practice Address - Street 1:13158 ODYSSEY LAKE WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4642
Practice Address - Country:US
Practice Address - Phone:352-630-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW246011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty