Provider Demographics
NPI:1447472253
Name:FARR, GLENN LEWIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:LEWIS
Last Name:FARR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 LUCKY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5440
Mailing Address - Country:US
Mailing Address - Phone:760-439-7618
Mailing Address - Fax:
Practice Address - Street 1:791 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1800
Practice Address - Country:US
Practice Address - Phone:909-824-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047481041C0700X
CA258651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical