Provider Demographics
NPI:1669719563
Name:FARRELL, JODY M (MS)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:M
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:JODY
Other - Middle Name:M
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:27 JAMES VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1258
Mailing Address - Country:US
Mailing Address - Phone:203-640-7809
Mailing Address - Fax:
Practice Address - Street 1:27 JAMES VINCENT DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1258
Practice Address - Country:US
Practice Address - Phone:203-640-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002626101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health