Healthcare Provider Details

I. General information

NPI: 1053408807
Provider Name (Legal Business Name): JOHN J. FLYNN LCSWR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225
US

IV. Provider business mailing address

1526 WALDEN AVENUE
CHEEKTOWAGA NY
14225
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-6700
  • Fax: 716-896-0318
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-896-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number038456-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: