Provider Demographics
NPI:1982751582
Name:FARRELL, KERRY M (EDD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:M
Last Name:FARRELL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-0129
Mailing Address - Country:US
Mailing Address - Phone:732-974-6881
Mailing Address - Fax:
Practice Address - Street 1:1405 3RD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1450
Practice Address - Country:US
Practice Address - Phone:732-974-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00326700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist