1700420767 NPI number — TINA FLANAGAN LICENSED MENTAL HEALTH COUNSELOR P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700420767 NPI number — TINA FLANAGAN LICENSED MENTAL HEALTH COUNSELOR P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TINA FLANAGAN LICENSED MENTAL HEALTH COUNSELOR P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1700420767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 PADDOCK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11763-4098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-627-4694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1777 VETERANS MEMORIAL HWY STE 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISLANDIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11749-1555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-630-6439
Provider Business Practice Location Address Fax Number:
631-630-6440
Provider Enumeration Date:
11/03/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FLANAGAN
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-627-4694

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001254125 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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