Provider Demographics
NPI:1972777498
Name:KHABAGNOTE, FARRAH ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:FARRAH
Middle Name:ANN
Last Name:KHABAGNOTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5489
Mailing Address - Country:US
Mailing Address - Phone:707-410-0540
Mailing Address - Fax:
Practice Address - Street 1:1369 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-5489
Practice Address - Country:US
Practice Address - Phone:707-410-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical