Provider Demographics
NPI:1396141388
Name:FARRELL-BELASCO, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FARRELL-BELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PARSONS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2002
Mailing Address - Country:US
Mailing Address - Phone:313-344-6228
Mailing Address - Fax:313-338-3098
Practice Address - Street 1:120 PARSONS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2002
Practice Address - Country:US
Practice Address - Phone:313-344-6228
Practice Address - Fax:313-338-3098
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088898104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker