Provider Demographics
NPI:1629398458
Name:FLAKE, ANN MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:FLAKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1735
Mailing Address - Country:US
Mailing Address - Phone:973-625-7070
Mailing Address - Fax:973-625-7110
Practice Address - Street 1:50 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1735
Practice Address - Country:US
Practice Address - Phone:973-625-7070
Practice Address - Fax:973-625-7110
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223319886OtherORGANIZATION TAX ID
NJ4138601Medicaid
NJ310050Medicaid