Provider Demographics
NPI:1396021242
Name:FARRAR, KAREN RENEE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:FARRAR
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:CONANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1344 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1714
Mailing Address - Country:US
Mailing Address - Phone:248-891-0991
Mailing Address - Fax:
Practice Address - Street 1:1344 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309
Practice Address - Country:US
Practice Address - Phone:248-891-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68010933191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid