Provider Demographics
NPI:1821588757
Name:FARMER, TERESA (PSYD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FARMER
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 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 4002
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-9645
Mailing Address - Fax:513-636-3800
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 4002
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-9645
Practice Address - Fax:513-636-3800
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07672103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent