Provider Demographics
NPI:1891828091
Name:FARRELL, SEELEY (RN)
Entity Type:Individual
Prefix:
First Name:SEELEY
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6561 MOKELUMNE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2210
Mailing Address - Country:US
Mailing Address - Phone:415-577-0370
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1001
Practice Address - Country:US
Practice Address - Phone:510-483-3030
Practice Address - Fax:510-483-2329
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA809979163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No101Y00000XBehavioral Health & Social Service ProvidersCounselor