Provider Demographics
NPI:1407187693
Name:FLAHERTY, ANA G (MA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:G
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:MAGNANI-FLAHERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:920 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLEN
Mailing Address - State:CA
Mailing Address - Zip Code:95442-9655
Mailing Address - Country:US
Mailing Address - Phone:707-996-9802
Mailing Address - Fax:
Practice Address - Street 1:793 1ST ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7036
Practice Address - Country:US
Practice Address - Phone:707-996-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist