Provider Demographics
NPI:1649665647
Name:FARRELL, LEROY LLOYD (LPN)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:LLOYD
Last Name:FARRELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13712 HOOK CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1814
Mailing Address - Country:US
Mailing Address - Phone:718-276-3563
Mailing Address - Fax:
Practice Address - Street 1:13712 HOOK CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1814
Practice Address - Country:US
Practice Address - Phone:718-276-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193844-1167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician