Provider Demographics
NPI:1144385907
Name:FARRELL, JACQUELYN D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:D
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 1:235 NICOLL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2670
Mailing Address - Country:US
Mailing Address - Phone:203-624-2600
Mailing Address - Fax:203-562-3262
Practice Address - Street 1:235 NICOLL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2670
Practice Address - Country:US
Practice Address - Phone:203-624-2600
Practice Address - Fax:203-562-3262
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0045011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical