Provider Demographics
NPI:1184121725
Name:CALLANAN-FLAGLE, PATRICE (LCSWC)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:CALLANAN-FLAGLE
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENWAY ST NW
Mailing Address - Street 2:STE 5
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3557
Mailing Address - Country:US
Mailing Address - Phone:410-760-9079
Mailing Address - Fax:410-760-1121
Practice Address - Street 1:1850 YORK RD
Practice Address - Street 2:STE K
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5122
Practice Address - Country:US
Practice Address - Phone:410-760-9079
Practice Address - Fax:410-760-1121
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD055501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical