Provider Demographics
NPI:1609008465
Name:FARR, BONNIE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:J
Last Name:FARR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SE 1ST AVE
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0477
Mailing Address - Country:US
Mailing Address - Phone:352-209-8649
Mailing Address - Fax:352-486-7884
Practice Address - Street 1:3002 SE 1ST AVE
Practice Address - Street 2:BUILDING 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0477
Practice Address - Country:US
Practice Address - Phone:352-209-8649
Practice Address - Fax:352-486-7884
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7147103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC686ZMedicare PIN