1053726406 NPI number — MS. KATHLEEN ANN FARRELL-PERRINI MSW

Table of content: MS. KATHLEEN ANN FARRELL-PERRINI MSW (NPI 1053726406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053726406 NPI number — MS. KATHLEEN ANN FARRELL-PERRINI MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL-PERRINI
Provider First Name:
KATHLEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053726406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4758 CASCADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-8190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-487-8267
Provider Business Mailing Address Fax Number:
803-324-8331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 DIVISION AVE S STE 3A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-988-9389
Provider Business Practice Location Address Fax Number:
616-732-6392
Provider Enumeration Date:
06/24/2014

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:  68801083233 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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