Provider Demographics
NPI:1639224900
Name:FARRELL, SANDRA LOUISE (LICAC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LOUISE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-6001
Mailing Address - Country:US
Mailing Address - Phone:978-281-4977
Mailing Address - Fax:978-281-4976
Practice Address - Street 1:25 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-6001
Practice Address - Country:US
Practice Address - Phone:978-281-4977
Practice Address - Fax:978-281-4976
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist