Provider Demographics
NPI:1003789124
Name:FARROW, JACQUELINE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:FARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1811
Mailing Address - Country:US
Mailing Address - Phone:413-301-2533
Mailing Address - Fax:413-304-7069
Practice Address - Street 1:154 MAIN ST
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1131
Practice Address - Country:US
Practice Address - Phone:413-301-2533
Practice Address - Fax:413-304-7069
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty