Provider Demographics
NPI:1619910940
Name:FLYNN, SEAN (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 E PIMA STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4380
Mailing Address - Country:US
Mailing Address - Phone:520-733-2524
Mailing Address - Fax:520-733-3444
Practice Address - Street 1:5920 E PIMA STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4380
Practice Address - Country:US
Practice Address - Phone:520-733-2524
Practice Address - Fax:520-733-3444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3444103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ613233Medicaid
P40942Medicare UPIN
AZ613233Medicaid