Basic Information
Provider Information
NPI: 1346306040
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLANAGAN
FirstName: MELISSA
MiddleName: JEANNE
NamePrefix:  
NameSuffix:  
Credential: CEIS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 344 S MAIN ST
Address2:  
City: SHARON
State: MA
PostalCode: 020671814
CountryCode: US
TelephoneNumber: 6179575489
FaxNumber:  
Practice Location
Address1: 384 WASHINGTON ST
Address2:  
City: NORWELL
State: MA
PostalCode: 020612010
CountryCode: US
TelephoneNumber: 7818716550
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/28/2006
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  N Behavioral Health & Social Service ProvidersCounselor 
101YM0800X6485MAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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