Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 86369 | CA |
NPI | 1003196551 |
---|---|
Provider Name | Mrs. Abby Ross Farnell |
First Address | Oakland, CA 94618-1416 |
Second Address | Oakland, CA 94618-1416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2011 |
Last Update Date | 15/04/2021 |