Healthcare Provider Details

I. General information

NPI: 1528800414
Provider Name (Legal Business Name): CORMAC JAMES FLYNN LMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 8TH ST
NEW YORK NY
10011-9039
US

IV. Provider business mailing address

33 W 8TH ST
NEW YORK NY
10011-9039
US

V. Phone/Fax

Practice location:
  • Phone: 646-543-4870
  • Fax:
Mailing address:
  • Phone: 646-543-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2632497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: