Provider Demographics
NPI:1023094877
Name:FARNELL, MARY M (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:FARNELL
Suffix:
Gender:F
Credentials:LCSW
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 5284
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-0284
Mailing Address - Country:US
Mailing Address - Phone:518-459-8977
Mailing Address - Fax:
Practice Address - Street 1:170 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1935
Practice Address - Country:US
Practice Address - Phone:518-459-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0704441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY362531OtherMVP
NYN176P1OtherBLUE CROSSS
NYDD6238Medicare ID - Type Unspecified
NYN176P1OtherBLUE CROSSS