Provider Demographics
NPI:1992395073
Name:FARRARE, JENNIFER (MED, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FARRARE
Suffix:
Gender:F
Credentials:MED, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 BAYLY RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2911
Mailing Address - Country:US
Mailing Address - Phone:410-901-7243
Mailing Address - Fax:
Practice Address - Street 1:911 BAYLY RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2911
Practice Address - Country:US
Practice Address - Phone:410-901-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X, 101YS0200X
MDLGP10409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool