Provider Demographics
NPI:1396721239
Name:FARRAN, BRIAN LAWRENCE (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAWRENCE
Last Name:FARRAN
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W SOUTH ORANGE AVE APT 5R
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1066
Mailing Address - Country:US
Mailing Address - Phone:973-327-4393
Mailing Address - Fax:973-352-6578
Practice Address - Street 1:111 S ORANGE AVE STE 24
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1931
Practice Address - Country:US
Practice Address - Phone:973-327-4393
Practice Address - Fax:973-352-6578
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016443103TC0700X
NJ4425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02693194Medicaid
NYVN0121Medicare PIN