Provider Demographics
NPI:1093581084
Name:FARISH, REBECAH LYNN
Entity Type:Individual
Prefix:
First Name:REBECAH
Middle Name:LYNN
Last Name:FARISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36341 LAKE UNITY RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5805
Mailing Address - Country:US
Mailing Address - Phone:352-467-5576
Mailing Address - Fax:
Practice Address - Street 1:36341 LAKE UNITY RD
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-5805
Practice Address - Country:US
Practice Address - Phone:352-467-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty