Provider Demographics
NPI:1821515610
Name:FLYNN, BLAIR ALEXANDRA
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:ALEXANDRA
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5029
Mailing Address - Country:US
Mailing Address - Phone:631-923-5668
Mailing Address - Fax:
Practice Address - Street 1:1650 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1738
Practice Address - Country:US
Practice Address - Phone:631-403-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health