Provider Demographics
NPI:1982034864
Name:FARLEY, ELISHA WENDI (LSW)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:WENDI
Last Name:FARLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:WENDI
Other - Last Name:ANTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2619 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2377
Mailing Address - Country:US
Mailing Address - Phone:215-390-6186
Mailing Address - Fax:
Practice Address - Street 1:2619 BARCLAY STREET
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-7519
Practice Address - Country:US
Practice Address - Phone:215-390-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018663251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health