Healthcare Provider Details

I. General information

NPI: 1992390488
Provider Name (Legal Business Name): JENNIFER ELLEN FARRELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
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 NumberPY10531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: