Provider Demographics
NPI:1801269808
Name:FARRALES, JAMES (LCSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:FARRALES
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1004
Mailing Address - Country:US
Mailing Address - Phone:203-562-2264
Mailing Address - Fax:203-401-2040
Practice Address - Street 1:67 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1004
Practice Address - Country:US
Practice Address - Phone:203-562-2264
Practice Address - Fax:203-401-2040
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical