Provider Demographics
NPI:1710039698
Name:FLANAGAN, JEANNETTE M (LCSW, CPAS, CTTS)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:M
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:LCSW, CPAS, CTTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1739
Mailing Address - Country:US
Mailing Address - Phone:201-664-0870
Mailing Address - Fax:201-391-1700
Practice Address - Street 1:390 HILLSDALE AVE
Practice Address - Street 2:REAR
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2759
Practice Address - Country:US
Practice Address - Phone:201-391-1700
Practice Address - Fax:201-391-1700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052362001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ047637Medicare ID - Type UnspecifiedMEDICARE PROVIDER