Provider Demographics
NPI:1184988974
Name:FLANAGAN, LISA ANN (MS SPECIAL ED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1252
Mailing Address - Country:US
Mailing Address - Phone:631-375-5143
Mailing Address - Fax:
Practice Address - Street 1:105 CLIFF RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1252
Practice Address - Country:US
Practice Address - Phone:631-375-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1546565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist