Provider Demographics
NPI:1164902888
Name:REARDON, JANINE FLANAGAN (LMHC)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:FLANAGAN
Last Name:REARDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOWLAND RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1918
Mailing Address - Country:US
Mailing Address - Phone:774-406-0122
Mailing Address - Fax:
Practice Address - Street 1:71 MAIN ST STE 1300B
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2791
Practice Address - Country:US
Practice Address - Phone:774-406-0122
Practice Address - Fax:508-433-1871
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty