Provider Demographics
NPI:1467747956
Name:BRENDA L. FARSIDE LCSW LLC
Entity Type:Organization
Organization Name:BRENDA L. FARSIDE LCSW LLC
Other - Org Name:KINDRED COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FARSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-438-2796
Mailing Address - Street 1:3519 SILVERSIDE RD
Mailing Address - Street 2:RIDGELY BLDG, SUITE 101B
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4909
Mailing Address - Country:US
Mailing Address - Phone:302-438-2796
Mailing Address - Fax:
Practice Address - Street 1:3519 SILVERSIDE RD
Practice Address - Street 2:RIDGELY BLDG, SUITE 101B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4909
Practice Address - Country:US
Practice Address - Phone:302-438-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00006121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty