Healthcare Provider Details

I. General information

NPI: 1861586059
Provider Name (Legal Business Name): DEBRA JEAN FLYNN-GONZALEZ M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAPLE ST
HOLYOKE MA
01040-5123
US

IV. Provider business mailing address

234 SAINT JAMES BLVD
SPRINGFIELD MA
01104-2913
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-0389
  • Fax:
Mailing address:
  • Phone: 413-747-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: