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NPI Code Detail

MEDICARE: DR. LEO F FLANAGAN JR. PH.D.

MEDICARE:  DR. LEO F FLANAGAN JR. PH.D.
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
1103TC0700XClinical Psychologist016132-1NY

General Provider Information

NPI Number : 1326292186
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEO F FLANAGAN JR. PH.D.
Provider Business Mailing Address
First Line : 74 BRIAR BRAE RD
Second Line :
City : STAMFORD
State : CT
Zip : 06903-1723
Country : US
Telephone Number : 203-561-9946
Fax Number :
Provider Business Practice Location Address
First Line : 411 THEODORE FREMD AVE
Second Line : SUITE 206 SOUTH
City : RYE
State : NY
Zip : 10580-1410
Country : US
Telephone Number : 203-561-9946
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2008
Last Update Date : 11/06/2008

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