Healthcare Provider Details

I. General information

NPI: 1306528666
Provider Name (Legal Business Name): JEANNE BRIDGET FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 VIA POINCIANA APT 101
LAKE WORTH FL
33467-2936
US

IV. Provider business mailing address

3959 VIA POINCIANA APT 101
LAKE WORTH FL
33467-2936
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-0724
  • Fax:
Mailing address:
  • Phone: 401-447-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB887621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: