Provider Demographics
NPI:1801159934
Name:FLAHERTY, LISA ANNE (MSED)
Entity type:Individual
Prefix:MRS
First Name:LISA ANNE
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SERENE PL
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3535
Mailing Address - Country:US
Mailing Address - Phone:631-988-9209
Mailing Address - Fax:
Practice Address - Street 1:72 SERENE PL
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3535
Practice Address - Country:US
Practice Address - Phone:631-988-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2137223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2137223OtherSPECIAL EDUCATION TEACHER