Provider Demographics
NPI:1720211014
Name:FLAHERTY, LINDA B (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 FLAGSHIP DR
Mailing Address - Street 2:#102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4580
Mailing Address - Country:US
Mailing Address - Phone:239-292-5176
Mailing Address - Fax:239-482-1796
Practice Address - Street 1:4616 FLAGSHIP DR
Practice Address - Street 2:#102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4580
Practice Address - Country:US
Practice Address - Phone:239-292-5176
Practice Address - Fax:239-482-1796
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5119103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical