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General NPI Number Information
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NPI Number | 1245756246
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Entity Type | Individual
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Provider Name | JACQUELYN ANNE FARASAT MC, NCC, M.ED.
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 22 S 40TH ST STE 201B
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5827
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Country | US
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Telephone | 617-379-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 22 S 40TH ST STE 201B
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5827
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Country | US
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Telephone | 617-379-0496
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00902700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC011506
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC04190
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License Number State | AL
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