Healthcare Provider Details

I. General information

NPI: 1760052005
Provider Name (Legal Business Name): JENNIFER FARRELL PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 WILLA SPRINGS DR STE 2013
WINTER SPRINGS FL
32708-6625
US

IV. Provider business mailing address

1114 N BLACK ACRE CT
WINTER SPRINGS FL
32708-4432
US

V. Phone/Fax

Practice location:
  • Phone: 407-753-7473
  • Fax:
Mailing address:
  • Phone: 937-765-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER ELLEN FARRELL
Title or Position: COUNSELING PSYCHOLOGIST
Credential: PH.D.
Phone: 937-765-0654