Provider Demographics
NPI:1295036176
Name:FARREY, SCOTTMICHAEL
Entity Type:Individual
Prefix:
First Name:SCOTTMICHAEL
Middle Name:
Last Name:FARREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5153
Mailing Address - Country:US
Mailing Address - Phone:860-343-5500
Mailing Address - Fax:860-343-5517
Practice Address - Street 1:955 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5153
Practice Address - Country:US
Practice Address - Phone:860-343-5500
Practice Address - Fax:860-343-5517
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator