Provider Demographics
NPI:1053911131
Name:LEE, MEGAN FLANAGAN
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:FLANAGAN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 KINDERKAMACK RD UNIT 309
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2187
Mailing Address - Country:US
Mailing Address - Phone:201-925-4620
Mailing Address - Fax:
Practice Address - Street 1:230 KINDERKAMACK RD UNIT 309
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2187
Practice Address - Country:US
Practice Address - Phone:201-925-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0863951041C0700X
NJ44SC058416001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical