Provider Demographics
NPI:1801117817
Name:FARRELL, DANIELLE ELISE (LICSW-SOCIAL WORK)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELISE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LICSW-SOCIAL WORK
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:FARRELL
Other - Last Name:BLANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4121 S VAN BUREN ST
Mailing Address - Street 2:UNIT 903
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-8559
Mailing Address - Country:US
Mailing Address - Phone:616-990-4123
Mailing Address - Fax:
Practice Address - Street 1:529 N GRAND ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3216
Practice Address - Country:US
Practice Address - Phone:580-234-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010921011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical