Provider Demographics
NPI:1003334251
Name:FLANIGAN-LANDEROS, KATIE JEAN (PSYD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JEAN
Last Name:FLANIGAN-LANDEROS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:JEAN
Other - Last Name:FLANIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:400 CONTINENTAL BLVD FL 6
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5074
Mailing Address - Country:US
Mailing Address - Phone:310-990-2138
Mailing Address - Fax:
Practice Address - Street 1:400 CONTINENTAL BLVD FL 6
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5074
Practice Address - Country:US
Practice Address - Phone:310-990-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34992103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical