Healthcare Provider Details

I. General information

NPI: 1295203545
Provider Name (Legal Business Name): LANDMARK PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 EASTMAN ST STE 4
SOUTH EASTON MA
02375-1279
US

IV. Provider business mailing address

82 ROCKLAND ST
NORTH EASTON MA
02356-2631
US

V. Phone/Fax

Practice location:
  • Phone: 508-682-1334
  • Fax:
Mailing address:
  • Phone: 617-780-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER WALTON FLYNN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 617-780-0461