Provider Demographics
NPI:1619440609
Name:FARRELL, LEA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ANNE
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 1:253 PARKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1719
Mailing Address - Country:US
Mailing Address - Phone:201-575-0679
Mailing Address - Fax:
Practice Address - Street 1:253 PARKSIDE RD
Practice Address - Street 2:
Practice Address - City:HARRINGTON PK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1719
Practice Address - Country:US
Practice Address - Phone:201-575-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087619-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical