Provider Demographics
NPI:1457998171
Name:FARRINGTON, DEEANNA VANESSA
Entity Type:Individual
Prefix:
First Name:DEEANNA
Middle Name:VANESSA
Last Name:FARRINGTON
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 1:933 SW LONGFELLOW RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2328
Mailing Address - Country:US
Mailing Address - Phone:561-308-7885
Mailing Address - Fax:
Practice Address - Street 1:933 SW LONGFELLOW RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2328
Practice Address - Country:US
Practice Address - Phone:561-308-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL166131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical