Provider Demographics
NPI:1114150422
Name:FARRELL, CASSANDRA LEIGH
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:FARRELL
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 1:200 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5433
Mailing Address - Country:US
Mailing Address - Phone:716-661-8330
Mailing Address - Fax:716-661-8364
Practice Address - Street 1:7 N ERIE ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-1095
Practice Address - Country:US
Practice Address - Phone:716-753-4104
Practice Address - Fax:716-753-4230
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY097524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program