Healthcare Provider Details

I. General information

NPI: 1487867966
Provider Name (Legal Business Name): MR. RICHARD D FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD D FLYNN LICSW

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

7 SCHOOL ST
WARREN RI
02885-3323
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 401-245-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02063
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: