Provider Demographics
NPI:1528511466
Name:FARNGALO, ROSEMARIE
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:FARNGALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S HIDDEN HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-4007
Mailing Address - Country:US
Mailing Address - Phone:678-508-7110
Mailing Address - Fax:
Practice Address - Street 1:1650 S HIDDEN HILLS PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-4007
Practice Address - Country:US
Practice Address - Phone:678-508-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool