Provider Demographics
NPI:1205951407
Name:FARRELL, CATHERINE JEANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:JEANNE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:JEANNE
Other - Last Name:BLEAU FARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:142 GOETHALS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1928
Mailing Address - Country:US
Mailing Address - Phone:585-225-0059
Mailing Address - Fax:585-225-0188
Practice Address - Street 1:45 WEBSTER COMMONS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3813
Practice Address - Country:US
Practice Address - Phone:585-872-2970
Practice Address - Fax:585-225-0188
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050028-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02308836Medicaid
NY02308836Medicaid