Healthcare Provider Details

I. General information

NPI: 1285115477
Provider Name (Legal Business Name): MARGARET FLYNN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 LA MAIDA ST APT 6
VALLEY VILLAGE CA
91607-3603
US

IV. Provider business mailing address

12121 LA MAIDA ST APT 6
VALLEY VILLAGE CA
91607-3603
US

V. Phone/Fax

Practice location:
  • Phone: 818-358-4284
  • Fax:
Mailing address:
  • Phone: 818-358-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10277723-SW-LICSW
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: