Provider Demographics
NPI:1508915026
Name:FARRELL, KAREN JILL (LMSW,CM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JILL
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LMSW,CM
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW,CM
Mailing Address - Street 1:28592 ORCHARD LAKE RD
Mailing Address - Street 2:301
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2961
Mailing Address - Country:US
Mailing Address - Phone:248-538-0261
Mailing Address - Fax:
Practice Address - Street 1:28592 ORCHARD LAKE RD
Practice Address - Street 2:301
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2961
Practice Address - Country:US
Practice Address - Phone:248-538-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010760471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008957350OtherBLUE CROSS BLUE SHIELD
MI1104816867OtherNPI COMMUNITY BASED RESOU