Provider Demographics
NPI:1689711418
Name:FARRELL, CANDACE LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:LEIGH
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 1:1001 BALTIMORE PIKE STE 208
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2852
Mailing Address - Country:US
Mailing Address - Phone:215-590-7555
Mailing Address - Fax:
Practice Address - Street 1:1001 BALTIMORE PIKE STE 208
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2852
Practice Address - Country:US
Practice Address - Phone:215-590-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040064611041C0700X
PACW0207241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103777332Medicaid