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Individual

BASIM ABRAHAM FARAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA CLINICAL PSY

Contact information

Practice address
1800 GRAVENSTEIN HWY N, SEBASTOPOL, CA 95472-2607
(707) 634-9055
Mailing address
2631 WILD BILL WAY, SANTA ROSA, CA 95407-4561
(971) 344-7914

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSB94022610
CA
225C00000X
Rehabilitation Counselor
Primary
PSB 94022610
CA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
06/26/2012
Last updated
08/10/2016
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