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General NPI Number Information
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NPI Number | 1184789224
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Entity Type | Individual
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Provider Name | MARY ELIZABETH MOORE-FARRELL LISW
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5701 N HIGH ST SUITE 208
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City | WORTHINGTON
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State | OH
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Zip | 43085-3973
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Country | US
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Telephone | 614-847-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 3199 MARTIN RD
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City | DUBLIN
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State | OH
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Zip | 43017-1451
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Country | US
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Telephone | 614-799-2194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-0005426
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License Number State | OH
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