Provider Demographics
NPI:1275984502
Name:FARRELL, NICOLE SAGAN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SAGAN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 BAYSHORE ROAD
Mailing Address - Street 2:FAMILIES MATTER LLC
Mailing Address - City:VILLAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08251
Mailing Address - Country:US
Mailing Address - Phone:609-886-8666
Mailing Address - Fax:
Practice Address - Street 1:899 BAYSHORE ROAD
Practice Address - Street 2:FAMILIES MATTER LLC
Practice Address - City:VILLAS
Practice Address - State:NJ
Practice Address - Zip Code:08251
Practice Address - Country:US
Practice Address - Phone:609-886-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00597500101YM0800X
NJ37AC00233600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health