Healthcare Provider Details

I. General information

NPI: 1285561563
Provider Name (Legal Business Name): KEVAN FLANAGAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ENTRANCE F, 370 MERRIMACK STREET BUILDING 5 SUITE 120
LAWRENCE MA
01843
US

IV. Provider business mailing address

ENTRANCE F, 370 MERRIMACK STREET BUILDING 5 SUITE 120
LAWRENCE MA
01843
US

V. Phone/Fax

Practice location:
  • Phone: 978-620-0290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: