Provider Demographics
NPI:1821668278
Name:FARWARD, AMBER AUTUMN (MA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:AUTUMN
Last Name:FARWARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 W CHOCOLATE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1632
Mailing Address - Country:US
Mailing Address - Phone:717-823-2361
Mailing Address - Fax:717-704-8476
Practice Address - Street 1:48 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3816
Practice Address - Country:US
Practice Address - Phone:717-823-2361
Practice Address - Fax:717-704-8476
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101Y00000XMedicaid