Provider Demographics
NPI:1336706449
Name:FLYNN, SIOBHAN MICHELLE (MS BCBA)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:MICHELLE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-2008
Mailing Address - Country:US
Mailing Address - Phone:774-269-9340
Mailing Address - Fax:
Practice Address - Street 1:45 POND ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1627
Practice Address - Country:US
Practice Address - Phone:781-421-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-19-35302103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst