Provider Demographics
NPI:1497092423
Name:VALLE-FARROW, BEVERLY (OSC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:VALLE-FARROW
Suffix:
Gender:F
Credentials:OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-0195
Mailing Address - Country:US
Mailing Address - Phone:845-551-7524
Mailing Address - Fax:845-651-2258
Practice Address - Street 1:1751 ROUTE 17A
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-0195
Practice Address - Country:US
Practice Address - Phone:845-551-7524
Practice Address - Fax:845-651-2258
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171M00000XOtherOSC