Provider Demographics
NPI:1336940881
Name:FARMER, REBECCA BROOKE (LGSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BROOKE
Last Name:FARMER
Suffix:
Gender:
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 RACE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7366
Mailing Address - Country:US
Mailing Address - Phone:513-904-5073
Mailing Address - Fax:
Practice Address - Street 1:158 DYE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2636
Practice Address - Country:US
Practice Address - Phone:304-910-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00947095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health