Provider Demographics
NPI:1619285640
Name:FLYNN, JENNIFER MARIE (CADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1921
Mailing Address - Country:US
Mailing Address - Phone:207-860-4061
Mailing Address - Fax:207-860-4063
Practice Address - Street 1:186 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1921
Practice Address - Country:US
Practice Address - Phone:207-860-4061
Practice Address - Fax:207-860-4063
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4563101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)