Healthcare Provider Details

I. General information

NPI: 1588893531
Provider Name (Legal Business Name): LAUREN MARIE FLAHERTY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MONTAUK HWY. SUITE 152
BABYLON NY
11702
US

IV. Provider business mailing address

30 MARY AVE
RONKONKOMA NY
11779-6750
US

V. Phone/Fax

Practice location:
  • Phone: 631-669-7098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019210
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: