Provider Demographics
NPI:1619578747
Name:FLYNN, AMELIA (LMFT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 N BROADWAY # 340
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2106
Mailing Address - Country:US
Mailing Address - Phone:516-902-9214
Mailing Address - Fax:
Practice Address - Street 1:6 E 39TH ST STE 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0448
Practice Address - Country:US
Practice Address - Phone:516-902-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty