Provider Demographics
NPI:1992796932
Name:FARRAR, ROSE M (LISW-S/ LICDC)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:M
Last Name:FARRAR
Suffix:
Gender:F
Credentials:LISW-S/ LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 EL CAMINO DR.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1318
Mailing Address - Country:US
Mailing Address - Phone:937-342-9030
Mailing Address - Fax:937-390-9039
Practice Address - Street 1:3160 EL CAMINO DR.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1318
Practice Address - Country:US
Practice Address - Phone:937-342-9030
Practice Address - Fax:937-390-9039
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00071701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007254128OtherAETNA
OH000000004491OtherANTHEM