Provider Demographics
NPI:1487338935
Name:FARLEY, LINA CHERKASOVA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:CHERKASOVA
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 HEARTLAND TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1982
Mailing Address - Country:US
Mailing Address - Phone:608-294-6088
Mailing Address - Fax:608-824-2675
Practice Address - Street 1:744 HEARTLAND TRL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1982
Practice Address - Country:US
Practice Address - Phone:608-294-6088
Practice Address - Fax:608-824-2675
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5193-57103G00000X
NY024702-01103TC2200X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487338935Medicaid