Provider Demographics
NPI:1215208558
Name:FARR, CORNELIA
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:FARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORNELIA
Other - Middle Name:
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5130 VINCITOR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3223
Mailing Address - Country:US
Mailing Address - Phone:702-255-2916
Mailing Address - Fax:702-255-2916
Practice Address - Street 1:5130 VINCITOR ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-3223
Practice Address - Country:US
Practice Address - Phone:702-255-2916
Practice Address - Fax:702-255-2916
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2266-C103K00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical