Provider Demographics
NPI:1699403535
Name:JEANTEL, FARAH (LCSW)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:JEANTEL
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 1:1 JOHN F KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3204
Mailing Address - Country:US
Mailing Address - Phone:845-709-1274
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-3204
Practice Address - Country:US
Practice Address - Phone:845-709-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090006-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker