Healthcare Provider Details

I. General information

NPI: 1245989110
Provider Name (Legal Business Name): BRENDA E FLYNN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 06/06/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S PATRICK DR
PATRICK AFB FL
32925-3516
US

IV. Provider business mailing address

1020 S PATRICK DR
PATRICK AFB FL
32925-3516
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-6997
  • Fax:
Mailing address:
  • Phone: 321-494-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: