Provider Demographics
NPI:1669742474
Name:BOENER, MARY FLYNN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FLYNN
Last Name:BOENER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-2320
Mailing Address - Country:US
Mailing Address - Phone:386-676-7175
Mailing Address - Fax:386-676-7134
Practice Address - Street 1:1340 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-2320
Practice Address - Country:US
Practice Address - Phone:386-676-7175
Practice Address - Fax:386-676-7134
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 85771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical