Provider Demographics
NPI:1154448785
Name:FLANNERY-BLACHURA, THERESA (MSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:FLANNERY-BLACHURA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1877
Mailing Address - Country:US
Mailing Address - Phone:207-532-6523
Mailing Address - Fax:207-532-3873
Practice Address - Street 1:11 MILL ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1877
Practice Address - Country:US
Practice Address - Phone:207-532-6523
Practice Address - Fax:207-532-3873
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC115571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432024199OtherMAINE CARE NUMBER