Provider Demographics
NPI:1962585240
Name:FARRELL, PATRICIA A (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1525
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-0525
Mailing Address - Country:US
Mailing Address - Phone:201-417-1827
Mailing Address - Fax:201-944-6137
Practice Address - Street 1:600 E PALISADE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1828
Practice Address - Country:US
Practice Address - Phone:201-417-1827
Practice Address - Fax:201-944-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100285400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FA696285Medicare UPIN