Provider Demographics
NPI:1497817076
Name:FLANNERY, MICHAEL L (CSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:FLANNERY
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34589 SUMMERS ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5327
Mailing Address - Country:US
Mailing Address - Phone:734-246-8282
Mailing Address - Fax:734-246-5714
Practice Address - Street 1:34589 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5327
Practice Address - Country:US
Practice Address - Phone:734-246-8282
Practice Address - Fax:734-246-5714
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010355951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0891416OtherBLUE CROSS OF MICHIGAN
MI0891416OtherBLUE CROSS OF MICHIGAN