Healthcare Provider Details

I. General information

NPI: 1619578747
Provider Name (Legal Business Name): AMELIA FLYNN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E 39TH ST STE 503
NEW YORK NY
10016-0448
US

IV. Provider business mailing address

471 N BROADWAY # 340
JERICHO NY
11753-2106
US

V. Phone/Fax

Practice location:
  • Phone: 516-902-9214
  • Fax:
Mailing address:
  • Phone: 516-902-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: