Provider Demographics
NPI:1295771327
Name:FLYNN, KEVIN C (PHD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1468
Mailing Address - Country:US
Mailing Address - Phone:508-238-7766
Mailing Address - Fax:508-230-5089
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1468
Practice Address - Country:US
Practice Address - Phone:508-238-7766
Practice Address - Fax:508-230-5089
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA710606OtherTUFTS HEALTH PLAN
MA1899546Medicaid
MAWO1880OtherBC BS OF MASSACHUSETTS
MA710606OtherTUFTS HEALTH PLAN