Provider Demographics
NPI:1497769996
Name:FLYNN, MADELEINE LUCILLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:LUCILLE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WATERCOURSE PL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3626
Mailing Address - Country:US
Mailing Address - Phone:781-582-1087
Mailing Address - Fax:781-585-6942
Practice Address - Street 1:28 WATERCOURSE PL
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3626
Practice Address - Country:US
Practice Address - Phone:781-582-1087
Practice Address - Fax:781-585-6942
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1011301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP2228801OtherMEDICARE PTAN