Provider Demographics
NPI:1063533347
Name:FLAHERTY, ANNE B (MS, CRC, CASAC, LMHC)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:B
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MS, CRC, CASAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-0462
Mailing Address - Country:US
Mailing Address - Phone:315-445-2291
Mailing Address - Fax:
Practice Address - Street 1:166 REVERE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1947
Practice Address - Country:US
Practice Address - Phone:315-445-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health