Basic Information
| Provider Information | |||||||||
| NPI: | 1104580810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MS, MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7E CLINTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146206529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155296843 | ||||||||
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| Practice Location | |||||||||
| Address1: | 490 E RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146211229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859222500 | ||||||||
| FaxNumber: | 5859222646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2021 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.