Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 5736 | NJ |
N | 103G00000X | Clinical Psychologist | 5736 | NJ |
N | 103TC0700X | Clinical Psychologist | 5736 | NJ |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 5736 | NJ |
NPI | 1124566617 |
---|---|
Provider Name | Enid Flagg |
First Address | Haddonfield, NJ 08033-3341 |
Second Address | Haddonfield, NJ 08033-3341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 06/02/2017 |