Provider Demographics
NPI:1700420767
Name:TINA FLANAGAN LICENSED MENTAL HEALTH COUNSELOR P.C.
Entity type:Organization
Organization Name:TINA FLANAGAN LICENSED MENTAL HEALTH COUNSELOR P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-627-4694
Mailing Address - Street 1:4 PADDOCK LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4098
Mailing Address - Country:US
Mailing Address - Phone:631-627-4694
Mailing Address - Fax:
Practice Address - Street 1:1777 VETERANS MEMORIAL HWY STE 14
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1555
Practice Address - Country:US
Practice Address - Phone:631-630-6439
Practice Address - Fax:631-630-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-03
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001254125Medicaid