Provider Demographics
NPI:1659517431
Name:FARBER, GERALD MARK (EDD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MARK
Last Name:FARBER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FREEDOM HOLW UNIT 218
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-6626
Mailing Address - Country:US
Mailing Address - Phone:978-744-3139
Mailing Address - Fax:
Practice Address - Street 1:50 FREEDOM HOLW UNIT 218
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-6626
Practice Address - Country:US
Practice Address - Phone:978-744-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAWO2808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist