Provider Demographics
NPI:1912289695
Name:FARAG, ANTWAN (MSW)
Entity type:Individual
Prefix:
First Name:ANTWAN
Middle Name:
Last Name:FARAG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15035 E AVENUE G
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-8892
Mailing Address - Country:US
Mailing Address - Phone:661-350-6555
Mailing Address - Fax:
Practice Address - Street 1:15035 E AVENUE G
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-8892
Practice Address - Country:US
Practice Address - Phone:661-350-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical