Provider Demographics
NPI:1518450527
Name:FARAH, WENDY LIN (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LIN
Last Name:FARAH
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LIN
Other - Last Name:ROELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:644 AINAPO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1042
Mailing Address - Country:US
Mailing Address - Phone:808-271-5321
Mailing Address - Fax:
Practice Address - Street 1:644 AINAPO ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1042
Practice Address - Country:US
Practice Address - Phone:808-271-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2023-02-07
Deactivation Date:2018-10-16
Deactivation Code:
Reactivation Date:2020-02-21
Provider Licenses
StateLicense IDTaxonomies
VA09040075521041C0700X
CT51481041C0700X
WALW601918301041C0700X
HI40061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical