Provider Demographics
NPI:1679587109
Name:FARNSWORTH, RONALD BRENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRENT
Last Name:FARNSWORTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15318 MCKAYS LARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6507
Mailing Address - Country:US
Mailing Address - Phone:203-641-1995
Mailing Address - Fax:
Practice Address - Street 1:4201 MEDICAL DR STE 330
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5805
Practice Address - Country:US
Practice Address - Phone:210-614-4990
Practice Address - Fax:210-614-4991
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002055103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist