1205073731 NPI number — MRS. LYNSEY VANGHEL FLAHERTY MSW, LCSW

Table of content: MRS. LYNSEY VANGHEL FLAHERTY MSW, LCSW (NPI 1205073731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205073731 NPI number — MRS. LYNSEY VANGHEL FLAHERTY MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLAHERTY
Provider First Name:
LYNSEY
Provider Middle Name:
VANGHEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205073731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 COTTSWOLD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING LAKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28390-7053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-258-2571
Provider Business Mailing Address Fax Number:
910-436-5343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 CHAPEL HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28390-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-916-7881
Provider Business Practice Location Address Fax Number:
910-436-5343
Provider Enumeration Date:
01/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C006317 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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