Provider Demographics
NPI:1508432527
Name:FARFAN, ELSA NOEMI (MA)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:NOEMI
Last Name:FARFAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:NOEMI
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:920 NE 142ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3216
Mailing Address - Country:US
Mailing Address - Phone:310-598-9140
Mailing Address - Fax:
Practice Address - Street 1:12550 BISCAYNE BLVD STE 507
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2544
Practice Address - Country:US
Practice Address - Phone:786-373-3027
Practice Address - Fax:786-802-2011
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical