Provider Demographics
NPI:1144067174
Name:FARRELL, EMMANUELLE JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:JEAN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 COREY RD APT 42
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-8332
Mailing Address - Country:US
Mailing Address - Phone:609-955-1007
Mailing Address - Fax:
Practice Address - Street 1:3 BOW ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5109
Practice Address - Country:US
Practice Address - Phone:617-547-2255
Practice Address - Fax:617-547-0558
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health