Provider Demographics
NPI:1023194842
Name:FLIPPEN, MONTINA LAYNALL (BA)
Entity Type:Individual
Prefix:MS
First Name:MONTINA
Middle Name:LAYNALL
Last Name:FLIPPEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 DOMEDION AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2108
Mailing Address - Country:US
Mailing Address - Phone:716-892-5101
Mailing Address - Fax:
Practice Address - Street 1:53 DOMEDION AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2108
Practice Address - Country:US
Practice Address - Phone:716-892-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health