Provider Demographics
NPI:1225368210
Name:FLYNN, MOLLY RAE
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:RAE
Last Name:FLYNN
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 1:8266 GWINHURST CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-7528
Mailing Address - Country:US
Mailing Address - Phone:916-289-5864
Mailing Address - Fax:
Practice Address - Street 1:1507 21ST ST
Practice Address - Street 2:205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5220
Practice Address - Country:US
Practice Address - Phone:916-441-0123
Practice Address - Fax:916-441-6893
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker