Provider Demographics
NPI:1619008000
Name:FLAHERTY, SUSAN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 PARK AVE
Mailing Address - Street 2:STE. 2004
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3733
Mailing Address - Country:US
Mailing Address - Phone:516-785-8600
Mailing Address - Fax:516-785-8600
Practice Address - Street 1:3375 PARK AVE
Practice Address - Street 2:STE. 2004
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3733
Practice Address - Country:US
Practice Address - Phone:516-785-8600
Practice Address - Fax:516-785-8600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020810-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00151186OtherGHI PROVIDER ID
NY020810OtherHIP PROVIDER ID
NY64499OtherVYTRA HEALTH PLAN PROVIDE
NY110480OtherVALUE OPTIONS PROVIDER ID
NY7442OtherHORIZON HEALTHCARE ID
NY10509395OtherCAQH PROVIDER ID
NY4316325OtherAETNA PROVIDER ID
NY55247OtherHIP PAYOR ID
NY7442OtherHORIZON HEALTHCARE ID