Healthcare Provider Details

I. General information

NPI: 1275984502
Provider Name (Legal Business Name): NICOLE SAGAN FARRELL M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 ROUTE 47 S STE 9
RIO GRANDE NJ
08242-1609
US

IV. Provider business mailing address

1127 ROUTE 47 S STE 9
RIO GRANDE NJ
08242-1609
US

V. Phone/Fax

Practice location:
  • Phone: 609-486-2003
  • Fax:
Mailing address:
  • Phone: 609-486-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00597500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: