Provider Demographics
NPI:1740582196
Name:FLYNN, EDWARD T (MED, LMHC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:T
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 TURNPIKE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2703
Mailing Address - Country:US
Mailing Address - Phone:617-326-3014
Mailing Address - Fax:617-326-3013
Practice Address - Street 1:354 TURNPIKE ST STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2703
Practice Address - Country:US
Practice Address - Phone:617-326-3014
Practice Address - Fax:617-326-3013
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health