Provider Demographics
NPI:1952450454
Name:FLANAGAN-SOUSA, DONNA M (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:FLANAGAN-SOUSA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4875
Mailing Address - Country:US
Mailing Address - Phone:603-673-2508
Mailing Address - Fax:603-673-2712
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4875
Practice Address - Country:US
Practice Address - Phone:603-673-2508
Practice Address - Fax:603-673-2712
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420948Medicaid
NH30420948Medicaid