Healthcare Provider Details

I. General information

NPI: 1467724385
Provider Name (Legal Business Name): SHANNON MARIE FLANAGAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NEWBURG AVE STE 101
CATONSVILLE MD
21228-5168
US

IV. Provider business mailing address

427 OVERBROOK RD
CATONSVILLE MD
21228-1824
US

V. Phone/Fax

Practice location:
  • Phone: 215-253-9365
  • Fax:
Mailing address:
  • Phone: 215-253-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21727
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: