Provider Demographics
NPI:1841507217
Name:FARRELL, KATHLEEN MARY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1434
Mailing Address - Country:US
Mailing Address - Phone:718-351-6398
Mailing Address - Fax:718-351-6307
Practice Address - Street 1:3651 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1434
Practice Address - Country:US
Practice Address - Phone:718-351-6398
Practice Address - Fax:718-351-6307
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003800-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist