Healthcare Provider Details

I. General information

NPI: 1841772167
Provider Name (Legal Business Name): LIAM HENRY FARRELL MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

IV. Provider business mailing address

16 CHARLES ST
BURLINGTON VT
05401-3627
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-4208
  • Fax:
Mailing address:
  • Phone: 802-503-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0134059
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: