Healthcare Provider Details

I. General information

NPI: 1962790196
Provider Name (Legal Business Name): DONNA E. FLYNN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SHERWOOD DR
OTISFIELD ME
04270-7437
US

IV. Provider business mailing address

45 SHERWOOD DR
OTISFIELD ME
04270-7437
US

V. Phone/Fax

Practice location:
  • Phone: 207-570-8014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: