Marjorie Farmer, MSW, LICSW

Individual provider Active NPI Clinical Social Worker · Mystic, CT

NPI 1992288161 · NPPES record last updated Sep 12, 2018

Key facts

NPI
1992288161
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
009382 (CT)
Practice address
295 Pequot Ave
Mystic, CT 06355-1739
Phone
(617) 947-7602
NPI assigned
Sep 12, 2018
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
009382CTMDClinical Social Worker
118448MAMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 118448 MA
Clinical Social Worker 1041C0700X 009382 CT Yes

Addresses

Primary practice location

295 Pequot Ave
Mystic, CT 06355-1739

Mailing address

295 Pequot Ave
Mystic, CT 06355-1739
Phone (617) 947-7602

Other providers in Mystic, CT

All providers in Mystic, CT · Clinical Social Worker in Connecticut

Sources for this page

Verify at the official NPI Registry.