Provider Demographics
NPI:1407512882
Name:FARKAS, ALICIA (MSSA, LSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:FARKAS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA, LSW
Mailing Address - Street 1:10176 HESS MILL RD NE APT D
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8658
Mailing Address - Country:US
Mailing Address - Phone:330-280-4574
Mailing Address - Fax:
Practice Address - Street 1:2416 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1514
Practice Address - Country:US
Practice Address - Phone:330-305-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005524104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker