1205951407 NPI number — MS. CATHERINE JEANNE FARRELL LCSW

Table of content: MS. CATHERINE JEANNE FARRELL LCSW (NPI 1205951407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205951407 NPI number — MS. CATHERINE JEANNE FARRELL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL
Provider First Name:
CATHERINE
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLEAU FARRELL
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
JEANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205951407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 GOETHALS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14616-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-225-0059
Provider Business Mailing Address Fax Number:
585-225-0188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 WEBSTER COMMONS BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14580-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-872-2970
Provider Business Practice Location Address Fax Number:
585-225-0188
Provider Enumeration Date:
03/20/2007

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:  R050028-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02308836 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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