Provider Demographics
NPI:1891116000
Name:FARRIS, AUDREY MARTIN (LISW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:MARTIN
Last Name:FARRIS
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3461 MARKET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4412
Mailing Address - Country:US
Mailing Address - Phone:717-219-3986
Mailing Address - Fax:
Practice Address - Street 1:3461 MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4412
Practice Address - Country:US
Practice Address - Phone:717-219-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128939104100000X
OH1.1801370104100000X
PACW018374104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker