Provider Demographics
NPI:1689339673
Name:FARLEY, MICHELE LOREN
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LOREN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:LOREN
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2011
Mailing Address - Country:US
Mailing Address - Phone:631-466-2288
Mailing Address - Fax:
Practice Address - Street 1:17 2ND AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2011
Practice Address - Country:US
Practice Address - Phone:631-466-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator