Provider Demographics
NPI:1053119263
Name:FARNUM, EDEN D
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:D
Last Name:FARNUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 DAVEY ST APT A
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-6168
Mailing Address - Country:US
Mailing Address - Phone:973-842-1613
Mailing Address - Fax:
Practice Address - Street 1:242 DAVEY ST APT A
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-6168
Practice Address - Country:US
Practice Address - Phone:973-842-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00052700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist