Basic Information
| Provider Information | |||||||||
| NPI: | 1659484814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLAGG | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMSW-CONDITIONAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 MELLEN ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041012186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078711582 | ||||||||
| FaxNumber: | 2078719276 | ||||||||
| Practice Location | |||||||||
| Address1: | 587 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041032701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078711582 | ||||||||
| FaxNumber: | 2078719276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | MC10561 | ME | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.