Provider Demographics
NPI:1972740983
Name:FARCA, MINDLE
Entity Type:Individual
Prefix:
First Name:MINDLE
Middle Name:
Last Name:FARCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 ROUTE 59
Practice Address - Street 2:SUITE 102
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3428
Practice Address - Country:US
Practice Address - Phone:845-368-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0168321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist