Healthcare Provider Details

I. General information

NPI: 1730898701
Provider Name (Legal Business Name): CASSIDY FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 02/12/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 W GIRARD AVE
PHILADELPHIA PA
19130-1313
US

IV. Provider business mailing address

2517 W GIRARD AVE
PHILADELPHIA PA
19130-1313
US

V. Phone/Fax

Practice location:
  • Phone: 267-507-1692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: