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General NPI Number Information
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NPI Number | 1992390488
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Entity Type | Individual
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Provider Name | JENNIFER ELLEN FARRELL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 1073 WILLA SPRINGS DR STE 2013
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-6625
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Country | US
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Telephone | 407-753-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 N BLACK ACRE CT
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-4432
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Country | US
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Telephone | 937-765-0654
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY10531
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License Number State | FL
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