Provider Demographics
NPI:1417407370
Name:FARRELL, MARY L (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 E SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5295
Mailing Address - Country:US
Mailing Address - Phone:575-242-1100
Mailing Address - Fax:575-993-5014
Practice Address - Street 1:2801 MISSOURI AVE STE 8
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5061
Practice Address - Country:US
Practice Address - Phone:575-242-1100
Practice Address - Fax:575-993-5014
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-105491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical