Provider Demographics
NPI:1700126984
Name:DVORAK-FARLING, THERESA LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:DVORAK-FARLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 OAKHURST RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-2157
Mailing Address - Country:US
Mailing Address - Phone:727-504-3041
Mailing Address - Fax:727-498-5522
Practice Address - Street 1:9160 OAKHURST RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2157
Practice Address - Country:US
Practice Address - Phone:727-504-3041
Practice Address - Fax:727-498-5522
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical