Provider Demographics
NPI:1043690654
Name:FARRARE, LARRY I (MED CAC-AD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:FARRARE
Suffix:I
Gender:M
Credentials:MED CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5352
Mailing Address - Country:US
Mailing Address - Phone:410-548-3333
Mailing Address - Fax:410-548-3341
Practice Address - Street 1:540 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5352
Practice Address - Country:US
Practice Address - Phone:410-548-3333
Practice Address - Fax:410-548-3341
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCAC-AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)