Provider Demographics
NPI:1689052052
Name:FARRAR, AMANDA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ST MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3878
Mailing Address - Country:US
Mailing Address - Phone:707-404-8055
Mailing Address - Fax:707-894-3686
Practice Address - Street 1:129 N CLOVERDALE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3384
Practice Address - Country:US
Practice Address - Phone:707-404-8055
Practice Address - Fax:707-894-3686
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical