1518450527 NPI number — WENDY LIN FARAH LCSW, LICSW

Table of content: WENDY LIN FARAH LCSW, LICSW (NPI 1518450527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518450527 NPI number — WENDY LIN FARAH LCSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARAH
Provider First Name:
WENDY
Provider Middle Name:
LIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROELLE
Provider Other First Name:
WENDY
Provider Other Middle Name:
LIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518450527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/16/2018
NPI Reactivation Date:
02/21/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
644 AINAPO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96825-1042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-271-5321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 AINAPO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96825-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-271-5321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904007552 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 5148 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LW60191830 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 4006 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)