Provider Demographics
NPI:1619622206
Name:FARRIS, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108F N READING RD # 18671721
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1668
Mailing Address - Country:US
Mailing Address - Phone:717-219-5711
Mailing Address - Fax:717-219-5712
Practice Address - Street 1:3111 SPRINGBANK LN STE I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3373
Practice Address - Country:US
Practice Address - Phone:855-675-4144
Practice Address - Fax:617-807-0958
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138658104100000X
NCP0202241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker