Provider Demographics
NPI:1346218393
Name:FARLEY, JENNIFER LEIGH (MSW LMSW RPT-S)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MSW LMSW RPT-S
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LMSW RPT-S
Mailing Address - Street 1:2200 N CANTON CENTER RD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5065
Mailing Address - Country:US
Mailing Address - Phone:734-786-4982
Mailing Address - Fax:
Practice Address - Street 1:2200 N CANTON CENTER RD
Practice Address - Street 2:SUITE 200B
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5065
Practice Address - Country:US
Practice Address - Phone:734-786-4982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801083471OtherLICENSE LMSW