Provider Demographics
NPI:1588947295
Name:FARLEY, JOSEPH P (MFT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:FARLEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 ALPINE RD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4495
Mailing Address - Country:US
Mailing Address - Phone:925-256-4670
Mailing Address - Fax:
Practice Address - Street 1:1148 ALPINE RD
Practice Address - Street 2:SUITE #205
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4495
Practice Address - Country:US
Practice Address - Phone:925-256-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34-2063110OtherEIN