Provider Demographics
NPI:1912351545
Name:FARLEY, DAVID LEWIS (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEWIS
Last Name:FARLEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UNIVERSITY AVE W
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3727
Mailing Address - Country:US
Mailing Address - Phone:651-232-2273
Mailing Address - Fax:651-232-4953
Practice Address - Street 1:1700 UNIVERSITY AVE W
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:651-232-2273
Practice Address - Fax:651-232-4953
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker