Provider Demographics
NPI:1366133837
Name:FARRELL, CORY ANN
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:ANN
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-2102
Mailing Address - Country:US
Mailing Address - Phone:209-550-7352
Mailing Address - Fax:209-521-7001
Practice Address - Street 1:1030 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-2102
Practice Address - Country:US
Practice Address - Phone:209-550-7352
Practice Address - Fax:209-521-7001
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)