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NPI Code Detail

MEDICARE: JUSTIN FARRELL MSW

MEDICARE: JUSTIN FARRELL 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
1104100000XSocial Worker
21041C0700XClinical Social WorkerLW60173078WA

General Provider Information

NPI Number : 1407052558
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN FARRELL MSW
Provider Business Mailing Address
First Line : 1498 SE TECH CENTER PL STE 300
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-5509
Country : US
Telephone Number : 360-619-2226
Fax Number : 360-326-9691
Provider Business Practice Location Address
First Line : 1498 SE TECH CENTER PL STE 300
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-5509
Country : US
Telephone Number : 360-619-2226
Fax Number : 360-326-9691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 02/14/2025

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