Provider Demographics
NPI:1437708880
Name:FARNESE, ALEXA (MA)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:FARNESE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4173
Mailing Address - Country:US
Mailing Address - Phone:973-865-3057
Mailing Address - Fax:
Practice Address - Street 1:925 BEAR CORBITT RD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1323
Practice Address - Country:US
Practice Address - Phone:302-454-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101026103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool