Provider Demographics
NPI:1821105438
Name:FLAHERTY, PAULA E (MS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:E
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GARDNER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-2160
Mailing Address - Country:US
Mailing Address - Phone:262-763-7766
Mailing Address - Fax:
Practice Address - Street 1:190 GARDNER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-2160
Practice Address - Country:US
Practice Address - Phone:262-763-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI799123101YM0800X
WI7991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40998800Medicaid