Provider Demographics
NPI:1740035252
Name:FAVARD, ROSE EMMANUELLA FARAH (LCSW)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:EMMANUELLA FARAH
Last Name:FAVARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 NW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3458
Mailing Address - Country:US
Mailing Address - Phone:850-999-3102
Mailing Address - Fax:
Practice Address - Street 1:540 NW 11TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3458
Practice Address - Country:US
Practice Address - Phone:850-999-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW246261041C0700X
FLISW18431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical