Healthcare Provider Details

I. General information

NPI: 1700064987
Provider Name (Legal Business Name): CAROLE FLYNN M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2008
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 WILLIAMS ST
MARLBOROUGH MA
01752-6049
US

IV. Provider business mailing address

320 W 38TH ST APT 1925
NEW YORK NY
10018-5255
US

V. Phone/Fax

Practice location:
  • Phone: 508-733-1562
  • Fax:
Mailing address:
  • Phone: 150-873-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number0279986
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: