Provider Demographics
NPI:1346231511
Name:FLYNN, PATRICIA ROSEMARY (MA LCSW R31675 PA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ROSEMARY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MA LCSW R31675 PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ORANGE ST
Mailing Address - Street 2:PATRICIA R FLYNN #5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1659
Mailing Address - Country:US
Mailing Address - Phone:718-624-7212
Mailing Address - Fax:
Practice Address - Street 1:117 W 13TH ST
Practice Address - Street 2:STE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:718-624-7212
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR316751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N2ZT71Medicare ID - Type UnspecifiedEMPIRE