Provider Demographics
NPI:1245092386
Name:FLAHERTY, MARY LAUREN (CCMA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LAUREN
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 DUCK CREEK RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-4141
Mailing Address - Country:US
Mailing Address - Phone:815-355-9130
Mailing Address - Fax:
Practice Address - Street 1:3459 ELBERT DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-6638
Practice Address - Country:US
Practice Address - Phone:815-355-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker