Provider Demographics
NPI:1043368327
Name:FARRELL, CHUCK (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 N WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1382
Mailing Address - Country:US
Mailing Address - Phone:520-322-4463
Mailing Address - Fax:520-795-3575
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3664
Practice Address - Country:US
Practice Address - Phone:520-322-4463
Practice Address - Fax:520-795-3575
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW06271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCSW627IMedicare ID - Type Unspecified
ZCSW627IMedicare PIN