Provider Demographics
NPI:1467733899
Name:FARA, MARTHA P (MSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:P
Last Name:FARA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 HUNTLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8208
Mailing Address - Country:US
Mailing Address - Phone:630-947-2517
Mailing Address - Fax:
Practice Address - Street 1:113 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4947
Practice Address - Country:US
Practice Address - Phone:630-947-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0047561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical