Provider Demographics
NPI:1659484814
Name:FLAGG, MICHELE L (LMSW-CONDITIONAL)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:FLAGG
Suffix:
Gender:F
Credentials:LMSW-CONDITIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MELLEN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2186
Mailing Address - Country:US
Mailing Address - Phone:207-871-1582
Mailing Address - Fax:207-871-9276
Practice Address - Street 1:587 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2701
Practice Address - Country:US
Practice Address - Phone:207-871-1582
Practice Address - Fax:207-871-9276
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10561104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker