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:MR
Other - First Name:EDWARD
Other - Middle Name:T
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:101 G3 CHESTNUT STREET
Mailing Address - Street 2:UNIT 3
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035
Mailing Address - Country:US
Mailing Address - Phone:617-842-0612
Mailing Address - Fax:
Practice Address - Street 1:101 G3 CHESTNUT STREET
Practice Address - Street 2:UNIT 3
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:617-842-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health