Provider Demographics
NPI:1821378613
Name:FLAHERTY, TONI M (MSSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1987
Mailing Address - Country:US
Mailing Address - Phone:952-474-3251
Mailing Address - Fax:952-474-0315
Practice Address - Street 1:478 2ND ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1987
Practice Address - Country:US
Practice Address - Phone:952-474-3251
Practice Address - Fax:952-474-0315
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN438964600Medicaid