Healthcare Provider Details

I. General information

NPI: 1447514195
Provider Name (Legal Business Name): ANNE ELIZABETH FARRELL LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 19 MILE RD
CLINTON TOWNSHIP MI
48038-1103
US

IV. Provider business mailing address

2054 MOORHOUSE ST
FERNDALE MI
48220-1197
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8700
  • Fax:
Mailing address:
  • Phone: 586-909-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801094445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: