Provider Demographics
NPI:1811221914
Name:BONNIE J. FARR, PSYD, PA
Entity Type:Organization
Organization Name:BONNIE J. FARR, PSYD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-209-8649
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7147103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC683AMedicare PIN