MEDICARE: MS. EILEEN M. FLANAGAN MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC42319	CA

General Provider Information

NPI Number	:	1306974118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN M. FLANAGAN MFT

Provider Business Mailing Address
First Line	:	5661 KEITH AVE
Second Line	:	SUITE 101
City	:	OAKLAND
State	:	CA
Zip	:	94618-1542
Country	:	US
Telephone Number	:	510-601-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	5661 KEITH AVE
Second Line	:	SUITE 101
City	:	OAKLAND
State	:	CA
Zip	:	94618-1542
Country	:	US
Telephone Number	:	510-601-1590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	04/23/2010

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