Provider Demographics
NPI:1093709586
Name:FLANIGAN, KATHLEEN M (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 GARDEN VIEW CT
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2470
Mailing Address - Country:US
Mailing Address - Phone:760-944-8287
Mailing Address - Fax:760-944-8287
Practice Address - Street 1:741 GARDEN VIEW CT
Practice Address - Street 2:SUITE 109
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2470
Practice Address - Country:US
Practice Address - Phone:760-944-8287
Practice Address - Fax:760-944-8287
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS103801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6749634Medicaid
CASW10380Medicare PIN