Doctor Name: | MRS. ROBERTA JEAN FARLEY |
NPI Number: | 1063782365 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1414 Main St Melrose Park, IL - 601603902 |
Business Phone Number: | 7087868513 |
Business Fax Number: | 7086813958 |
Mailing Address: | 1414 Main St, MELROSE PARK |
State: | IL |
Postal Code: | 601603902 |
Phone Number: | 7087868513 |
Fax Number: | 7086813958 |
NPI Enumeration Date: | 01/04/2012 |
NPI Last Update Date: | 01/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |