Healthcare Provider Details

I. General information

NPI: 1053726406
Provider Name (Legal Business Name): KATHLEEN ANN FARRELL-PERRINI MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DIVISION AVE S STE 3A
GRAND RAPIDS MI
49503-4501
US

IV. Provider business mailing address

4758 CASCADE AVE
ROCK HILL SC
29732-8190
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-9389
  • Fax: 616-732-6392
Mailing address:
  • Phone: 803-487-8267
  • Fax: 803-324-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68801083233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: