Provider Demographics
NPI:1407119308
Name:FLANAGAN - KELLY, KERRY ANN (MS)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:FLANAGAN - KELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1012
Mailing Address - Country:US
Mailing Address - Phone:516-791-0451
Mailing Address - Fax:
Practice Address - Street 1:149 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1012
Practice Address - Country:US
Practice Address - Phone:516-791-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency