Healthcare Provider Details

I. General information

NPI: 1235072620
Provider Name (Legal Business Name): SARA FLANNELLY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAIN RD
GLEN LYON PA
18617-1250
US

IV. Provider business mailing address

16 MAIN RD
GLEN LYON PA
18617-1250
US

V. Phone/Fax

Practice location:
  • Phone: 570-406-1107
  • Fax:
Mailing address:
  • Phone: 570-406-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW141525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: