Provider Demographics
NPI:1174826994
Name:M PATRICIA FARRELL PC
Entity Type:Organization
Organization Name:M PATRICIA FARRELL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-361-5677
Mailing Address - Street 1:13010 S CORNELL LN
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2165
Mailing Address - Country:US
Mailing Address - Phone:708-448-3875
Mailing Address - Fax:708-361-5390
Practice Address - Street 1:7270 W COLLEGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1154
Practice Address - Country:US
Practice Address - Phone:708-361-5677
Practice Address - Fax:708-361-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.003119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL381310Medicare UPIN