Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS-004317-L | PA |
N | 103T00000X | Psychologist | PS-004317-L | PA |
N | 103TA0700X | Adult Development & Aging Psychologist | PS-004317-L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS-004317-L | PA |
N | 103G00000X | Clinical Psychologist | PS-004317-L | PA |
N | 103TC0700X | Clinical Psychologist | PS-004317-L | PA |
N | 103TC1900X | Counseling Psychologist | PS-004317-L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS-004317-L | PA |
N | 103TF0000X | Family Psychologist | PS-004317-L | PA |
NPI | 1174684500 |
---|---|
Provider Name | Dr. James T. Flannick |
First Address | Beaver, PA 15009-2356 |
Second Address | Beaver, PA 15009-2356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0013973040002 | (05) | PA |
146035 | (02) | PA |
152012 | (02) | PA |
4635081 | (02) | PA |