Provider Demographics
NPI:1669696613
Name:FLANAGAN, JENNIFER MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 WYANDANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2231
Mailing Address - Country:US
Mailing Address - Phone:631-472-2629
Mailing Address - Fax:631-472-2629
Practice Address - Street 1:296 N MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2515
Practice Address - Country:US
Practice Address - Phone:631-472-2629
Practice Address - Fax:631-472-2629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053699-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8K171Medicare ID - Type Unspecified