Provider Demographics
NPI:1083798813
Name:FARRAR, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FARRAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S GLENBURNIE RD
Mailing Address - Street 2:STE. D-17
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2613
Mailing Address - Country:US
Mailing Address - Phone:252-634-2855
Mailing Address - Fax:252-634-2955
Practice Address - Street 1:1315 S GLENBURNIE RD
Practice Address - Street 2:STE. D-17
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2613
Practice Address - Country:US
Practice Address - Phone:252-634-2855
Practice Address - Fax:252-634-2955
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC194350OtherMEDCOST
NC6000876Medicaid
NC0346EOtherBC