Provider Demographics
NPI:1467533679
Name:FARLEY, RICHARD LEE (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:FARLEY
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 1:5359 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-454-2161
Mailing Address - Fax:858-454-8378
Practice Address - Street 1:5359 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-454-2161
Practice Address - Fax:858-454-8378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP7699Medicare UPIN
CACP7699Medicare ID - Type UnspecifiedPSYCHOLOGIST