Healthcare Provider Details

I. General information

NPI: 1982975314
Provider Name (Legal Business Name): KYLA MICHELLE FLANAGAN MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE 311
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

2041 MARTIN LUTHER KING JR AVE SE SUITE 311
WASHINGTON DC
20020-7024
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-7900
  • Fax: 202-610-3095
Mailing address:
  • Phone: 202-889-7900
  • Fax: 202-610-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG12274
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG50078079
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23340
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079277
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: