Provider Demographics
NPI:1659884898
Name:FARRELL, JUNE KATHERINE (MACP, LADCI, CADACII)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:KATHERINE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MACP, LADCI, CADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-0144
Mailing Address - Country:US
Mailing Address - Phone:508-394-3459
Mailing Address - Fax:
Practice Address - Street 1:179 RT 6A
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3206
Practice Address - Country:US
Practice Address - Phone:508-255-3584
Practice Address - Fax:508-255-3587
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1639219314Medicaid