Provider Demographics
NPI:1659657161
Name:HYSJULIEN, FLANNERY VANGSNES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FLANNERY
Middle Name:VANGSNES
Last Name:HYSJULIEN
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 1:215 N GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4166
Mailing Address - Country:US
Mailing Address - Phone:607-525-4200
Mailing Address - Fax:
Practice Address - Street 1:215 N GENEVA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4166
Practice Address - Country:US
Practice Address - Phone:607-252-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0099161041C0700X
NY0876801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical