MEDICARE: MR. GAVIN FLANAGAN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	068.0089767	VT

General Provider Information

NPI Number	:	1689867244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GAVIN FLANAGAN MA

Provider Business Mailing Address
First Line	:	PO BOX 322
Second Line	:
City	:	MIDDLEBURY
State	:	VT
Zip	:	05753-0322
Country	:	US
Telephone Number	:	802-735-9080
Fax Number	:	815-572-0389

Provider Business Practice Location Address
First Line	:	1028 LAKE DUNMORE RD
Second Line	:
City	:	SALISBURY
State	:	VT
Zip	:	05769-9755
Country	:	US
Telephone Number	:	802-735-9080
Fax Number	:	815-572-0389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	01/16/2021

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