Provider Demographics
NPI:1417268715
Name:FARMER, MICHELLE P (LADC1)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:P
Last Name:FARMER
Suffix:
Gender:F
Credentials:LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DAWN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:MA
Mailing Address - Zip Code:01504-1220
Mailing Address - Country:US
Mailing Address - Phone:508-883-6515
Mailing Address - Fax:
Practice Address - Street 1:49 L ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1511
Practice Address - Country:US
Practice Address - Phone:617-268-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1514101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1514OtherLADC1