Provider Demographics
NPI:1326380494
Name:FLYNN, DANIEL SIMON (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SIMON
Last Name:FLYNN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-4972
Mailing Address - Country:US
Mailing Address - Phone:203-494-9374
Mailing Address - Fax:
Practice Address - Street 1:26-28 W MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1573
Practice Address - Country:US
Practice Address - Phone:203-494-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical