Healthcare Provider Details

I. General information

NPI: 1952627762
Provider Name (Legal Business Name): VIRGINIA FLYNN MS., LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 JAMES ST
SYRACUSE NY
13206-2387
US

IV. Provider business mailing address

3300 JAMES ST
SYRACUSE NY
13206-2387
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-0300
  • Fax:
Mailing address:
  • Phone: 315-422-0300
  • 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: