Healthcare Provider Details

I. General information

NPI: 1215322326
Provider Name (Legal Business Name): TAMI FLAHERTY LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MAIN AVE
ALBANY NY
12206
US

IV. Provider business mailing address

160 N MAIN AVE
ALBANY NY
12206-1821
US

V. Phone/Fax

Practice location:
  • Phone: 518-437-6500
  • Fax: 518-437-6588
Mailing address:
  • Phone: 518-437-6500
  • Fax: 518-437-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number082376-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: