Provider Demographics
NPI:1093863755
Name:FARRELL, JILL H (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:H
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 1:403 BROKENBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4713
Mailing Address - Country:US
Mailing Address - Phone:757-810-8901
Mailing Address - Fax:757-253-4118
Practice Address - Street 1:1657 MERRIMAC TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5624
Practice Address - Country:US
Practice Address - Phone:757-220-3200
Practice Address - Fax:757-253-4371
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266051OtherANTHEM
VA527375OtherVALUE OPTIONS
VA363321OtherMANAGED HEALTH NET
VA527380OtherVALUE OPTIONS