Provider Demographics
NPI:1154497576
Name:FLYNN, WILLIAM BERCHMAN JR (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BERCHMAN
Last Name:FLYNN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SIMON ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3046
Mailing Address - Country:US
Mailing Address - Phone:603-888-4347
Mailing Address - Fax:603-577-9157
Practice Address - Street 1:39 SIMON ST STE 2A
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3046
Practice Address - Country:US
Practice Address - Phone:603-888-4347
Practice Address - Fax:603-577-9157
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH474103T00000X
MA4451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007758Medicaid
NH30007758Medicaid