Provider Demographics
NPI:1790946283
Name:FARRELL, MARY E (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:FARRELL
Suffix:
Gender:F
Credentials:AUDIOLOGIST
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 9450
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-0450
Mailing Address - Country:US
Mailing Address - Phone:518-389-1803
Mailing Address - Fax:
Practice Address - Street 1:414 MAPLE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5550
Practice Address - Country:US
Practice Address - Phone:518-583-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000938-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist