Provider Demographics
NPI:1245266188
Name:FARNSWORTH, CLAIRE R (LISW)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:R
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FRONT ST.
Mailing Address - Street 2:BOX 236
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758
Mailing Address - Country:US
Mailing Address - Phone:740-962-2601
Mailing Address - Fax:740-962-2601
Practice Address - Street 1:401 FRONT ST.
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758
Practice Address - Country:US
Practice Address - Phone:740-962-2601
Practice Address - Fax:740-962-2601
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI8661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632404Medicaid
OH2632404Medicaid