Provider Demographics
NPI:1316377237
Name:FARNSWORTH, ROXANE
Entity Type:Individual
Prefix:
First Name:ROXANE
Middle Name:
Last Name:FARNSWORTH
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 1:5220 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4828
Mailing Address - Country:US
Mailing Address - Phone:303-982-6755
Mailing Address - Fax:
Practice Address - Street 1:4851 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6715
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:303-432-5071
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2017-08-15
Deactivation Date:2014-06-16
Deactivation Code:
Reactivation Date:2017-08-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health