Provider Demographics
NPI:1578205977
Name:FARNKOFF, KYLEE (MED, LADC II)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:FARNKOFF
Suffix:
Gender:F
Credentials:MED, LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HENRY TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1332
Mailing Address - Country:US
Mailing Address - Phone:781-325-2818
Mailing Address - Fax:
Practice Address - Street 1:2 COURTHOUSE LN STE 3
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1723
Practice Address - Country:US
Practice Address - Phone:978-275-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)