Provider Demographics
NPI:1780108183
Name:FLYNN-YORK, ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:FLYNN-YORK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:HANNIFAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:411 BURROWS HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 BURROWS HILL RD
Practice Address - Street 2:
Practice Address - City:AMSTON
Practice Address - State:CT
Practice Address - Zip Code:06231-1230
Practice Address - Country:US
Practice Address - Phone:860-918-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health