MEDICARE: MS. KATHLEEN ANN FARRELL-PERRINI MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	68801083233	MI

General Provider Information

NPI Number	:	1053726406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN FARRELL-PERRINI MSW

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

Provider Business Practice Location Address
First Line	:	360 DIVISION AVE S STE 3A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4501
Country	:	US
Telephone Number	:	616-988-9389
Fax Number	:	616-732-6392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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