Provider Demographics
NPI:1295203545
Name:LANDMARK PSYCHOLOGY
Entity type:Organization
Organization Name:LANDMARK PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-780-0461
Mailing Address - Street 1:82 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2631
Mailing Address - Country:US
Mailing Address - Phone:617-780-0461
Mailing Address - Fax:
Practice Address - Street 1:45 EASTMAN ST STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1279
Practice Address - Country:US
Practice Address - Phone:508-682-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1053554568Medicaid