1356541247 NPI number — LEIGH ANNA EASON FARRELL MSW

Table of content: LEIGH ANNA EASON FARRELL MSW (NPI 1356541247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356541247 NPI number — LEIGH ANNA EASON FARRELL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL
Provider First Name:
LEIGH
Provider Middle Name:
ANNA EASON
Provider Name Prefix Text:
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:
1356541247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13350 W COLONIAL DR
Provider Second Line Business Mailing Address:
STE 340
Provider Business Mailing Address City Name:
WINTER GARDEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787-3977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-875-3700
Provider Business Mailing Address Fax Number:
407-522-4671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13350 W COLONIAL DR
Provider Second Line Business Practice Location Address:
STE 340
Provider Business Practice Location Address City Name:
WINTER GARDEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34787-3977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-875-3700
Provider Business Practice Location Address Fax Number:
407-522-4671
Provider Enumeration Date:
07/19/2007

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109546600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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