Basic Information
| Provider Information | |||||||||
| NPI: | 1225143357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARLEY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W FOREST HOME AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532152843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146476326 | ||||||||
| FaxNumber: | 4146718860 | ||||||||
| Practice Location | |||||||||
| Address1: | 14555 W NATIONAL AVE | ||||||||
| Address2: | #193 | ||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531514494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627968426 | ||||||||
| FaxNumber: | 2627968437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1502-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 459-124 | WI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.