Provider Demographics
NPI:1023310422
Name:FARMER, GWENDOLYN (LMSW)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:22325 LA GARONNE ST
Mailing Address - Street 2:APT. 601
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4047
Mailing Address - Country:US
Mailing Address - Phone:248-327-6196
Mailing Address - Fax:
Practice Address - Street 1:22325 LA GARONNE ST
Practice Address - Street 2:APT. 601
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4047
Practice Address - Country:US
Practice Address - Phone:248-327-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker