Provider Demographics
NPI:1952637126
Name:FARRELL, RIVER MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RIVER
Middle Name:MARIE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2124
Mailing Address - Country:US
Mailing Address - Phone:773-318-5567
Mailing Address - Fax:248-605-3525
Practice Address - Street 1:510 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2124
Practice Address - Country:US
Practice Address - Phone:773-318-5567
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014836103TC1900X
IL071007766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling