Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2877 | MA |
Y | 103T00000X | Psychologist | 2877 | MA |
NPI | 1013409705 |
---|---|
Provider Name | Prof. Marianne Daisy Farkas |
First Address | Lexington, MA 02421-7143 |
Second Address | Lexington, MA 02421-7143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2018 |
Last Update Date | 30/05/2018 |