Provider Demographics
NPI:1598028193
Name:FARBER, FALLON M (P-LCSW)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:M
Last Name:FARBER
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2141
Mailing Address - Country:US
Mailing Address - Phone:570-840-5399
Mailing Address - Fax:
Practice Address - Street 1:1409 PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2220
Practice Address - Country:US
Practice Address - Phone:910-641-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0072071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical