MEDICARE: MRS. MICHELLE P FARMER LADC1

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1514	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1514	OTHER	MA	LADC1

General Provider Information

NPI Number	:	1417268715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE P FARMER LADC1

Provider Business Mailing Address
First Line	:	4 DAWN ST
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504-1220
Country	:	US
Telephone Number	:	508-883-6515
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 L ST
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-1511
Country	:	US
Telephone Number	:	617-268-5000
Fax Number	:

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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