Provider Demographics
NPI:1962547182
Name:FARRAR, MERRY KATHLEEN (PSYD)
Entity type:Individual
Prefix:
First Name:MERRY
Middle Name:KATHLEEN
Last Name:FARRAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WARREN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28689-9271
Mailing Address - Country:US
Mailing Address - Phone:704-539-5654
Mailing Address - Fax:
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962547182Medicare UPIN