Healthcare Provider Details

I. General information

NPI: 1497769996
Provider Name (Legal Business Name): MADELEINE LUCILLE FLYNN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WATERCOURSE PL
PLYMOUTH MA
02360-3626
US

IV. Provider business mailing address

28 WATERCOURSE PL
PLYMOUTH MA
02360-3626
US

V. Phone/Fax

Practice location:
  • Phone: 781-582-1087
  • Fax: 781-585-6942
Mailing address:
  • Phone: 781-582-1087
  • Fax: 781-585-6942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101130
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: