Healthcare Provider Details

I. General information

NPI: 1407902075
Provider Name (Legal Business Name): JOANNA MAIELLA FARRELL MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANN ELLEN MAIELLA

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MAIN ROAD
MONTVILLE NJ
07045
US

IV. Provider business mailing address

21 EVANS PLACE C O NEW BRIDGE SERVICES INC
POMPTON PLAINS NJ
07444
US

V. Phone/Fax

Practice location:
  • Phone: 973-316-9333
  • Fax:
Mailing address:
  • Phone: 973-907-2700
  • Fax: 973-839-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05352700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: