Provider Demographics
NPI:1972520971
Name:FARB, JEFFREY BRENT (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRENT
Last Name:FARB
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BELLEVUE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1847
Mailing Address - Country:US
Mailing Address - Phone:314-645-7411
Mailing Address - Fax:314-645-5678
Practice Address - Street 1:1035 BELLEVUE AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1847
Practice Address - Country:US
Practice Address - Phone:314-645-7411
Practice Address - Fax:314-645-5678
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical