Provider Demographics
NPI:1265016745
Name:FARRELLY, LAUREN
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:FARRELLY
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 1:110 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2211
Mailing Address - Country:US
Mailing Address - Phone:973-714-1311
Mailing Address - Fax:
Practice Address - Street 1:110 2ND AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-2211
Practice Address - Country:US
Practice Address - Phone:973-714-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00505200101Y00000X
12-035221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor