Provider Demographics
NPI:1245384403
Name:FARINA, MICHAEL V (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
Last Name:FARINA
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:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1338
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1413 N ELM ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2773
Practice Address - Country:US
Practice Address - Phone:270-827-5469
Practice Address - Fax:270-826-3201
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129834103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100221400Medicaid