MEDICARE: KAREN JILL FARRELL L.M.S.W.,C.M.

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	6801076047	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8008957350	OTHER	MI	BLUE CROSS BLUE SHIELD
2	1104816867	OTHER	MI	NPI COMMUNITY BASED RESOU

General Provider Information

NPI Number	:	1508915026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN JILL FARRELL L.M.S.W.,C.M.

Provider Business Mailing Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:	301
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-538-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:	301
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-538-0261
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/20/2007

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