Provider Demographics
NPI:1710050513
Name:FARLEY, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FARLEY
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 1:41 CONE MT. RD.
Mailing Address - Street 2:
Mailing Address - City:WEST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06090
Mailing Address - Country:US
Mailing Address - Phone:860-653-6577
Mailing Address - Fax:
Practice Address - Street 1:61 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2809
Practice Address - Country:US
Practice Address - Phone:860-707-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical