Provider Demographics
NPI:1700511235
Name:FARR, COURTNEY (LSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FARR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:
Practice Address - Street 1:1902 OLDE HOMESTEAD LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5875
Practice Address - Country:US
Practice Address - Phone:717-390-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137917104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW137917OtherPA STATE LICENSE