Healthcare Provider Details

I. General information

NPI: 1063684470
Provider Name (Legal Business Name): LUCY D FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCY ELIZABETH DEMERJIAN M.D.

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 LAFAYETTE PL
GREENWICH CT
06830-5440
US

IV. Provider business mailing address

28 LAFAYETTE PL
GREENWICH CT
06830-5440
US

V. Phone/Fax

Practice location:
  • Phone: 203-918-2982
  • Fax:
Mailing address:
  • Phone: 203-918-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number225617
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number050546
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: