Provider Demographics
NPI:1376684373
Name:FARRELL, MARICEL CRISTINA (MSED, NCSP)
Entity Type:Individual
Prefix:MS
First Name:MARICEL
Middle Name:CRISTINA
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MSED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2104
Mailing Address - Country:US
Mailing Address - Phone:516-293-1022
Mailing Address - Fax:
Practice Address - Street 1:25 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2104
Practice Address - Country:US
Practice Address - Phone:516-293-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist