Provider Demographics
NPI:1760551766
Name:FLYNN, MELISSA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:RR1 BOX 1373
Mailing Address - Street 2:
Mailing Address - City:HOP BOTTOM
Mailing Address - State:PA
Mailing Address - Zip Code:18824-9739
Mailing Address - Country:US
Mailing Address - Phone:570-289-8747
Mailing Address - Fax:
Practice Address - Street 1:181 WEST TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1303
Practice Address - Country:US
Practice Address - Phone:570-836-2722
Practice Address - Fax:570-836-1068
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical