Provider Demographics
NPI:1851516116
Name:FLANNERY, CATHERINE JEAN (MD)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:JEAN
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STONE ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1017
Mailing Address - Country:US
Mailing Address - Phone:585-249-0967
Mailing Address - Fax:
Practice Address - Street 1:1357 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1005
Practice Address - Country:US
Practice Address - Phone:585-442-9601
Practice Address - Fax:585-442-9606
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164007103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2346OtherEXCELLUS BCBS