Provider Demographics
NPI:1881743268
Name:FLANNERY, RAYMOND BENEDICT JR (PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BENEDICT
Last Name:FLANNERY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2519
Mailing Address - Country:US
Mailing Address - Phone:617-969-6120
Mailing Address - Fax:
Practice Address - Street 1:305 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1681
Practice Address - Country:US
Practice Address - Phone:508-368-3517
Practice Address - Fax:508-363-1512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA549103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10596Medicaid