Provider Demographics
NPI:1679559959
Name:FARRA, ROBERT ROSS (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROSS
Last Name:FARRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 EMERSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3100
Mailing Address - Country:US
Mailing Address - Phone:312-607-8308
Mailing Address - Fax:
Practice Address - Street 1:1123 EMERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3100
Practice Address - Country:US
Practice Address - Phone:474-404-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005345101YP2500X, 101YP2500X
IL1490107701041C0700X, 1041C0700X
MI4101005359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist