Healthcare Provider Details

I. General information

NPI: 1508382581
Provider Name (Legal Business Name): SHEENA LEIGH FLYNN LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEENA LEIGH FLYNN LCSW-R

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARK SLOPE CENTER FOR MENTAL HEALTH 348 13TH STREET SUITE 203
PARK SLOPE NY
11215-1122
US

IV. Provider business mailing address

859 68TH STREET
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 718-788-2461
  • Fax: 718-788-8274
Mailing address:
  • Phone: 917-361-6055
  • Fax: 718-680-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: