Provider Demographics
NPI:1972657153
Name:FLYNN, MARK S (PSYD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 KINGSLEY AVE
Mailing Address - Street 2:SUITE 18A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4535
Mailing Address - Country:US
Mailing Address - Phone:904-269-3324
Mailing Address - Fax:904-264-2302
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:SUITE 18A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-269-3324
Practice Address - Fax:904-264-2302
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7164103TC0700X
FLPY7164103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical