Provider Demographics
NPI:1700083490
Name:FLYNN, TODD (LCSW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1246
Mailing Address - Country:US
Mailing Address - Phone:909-948-2735
Mailing Address - Fax:951-248-4021
Practice Address - Street 1:5225 CANYON CREST DR
Practice Address - Street 2:BUILDING 100, SUITE 103
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6301
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:951-248-4021
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS136001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical