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General NPI Number Information
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NPI Number | 1376054148
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Entity Type | Organization
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Legal Business Name | JOANN FLYNN LLC.
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 3 SWANSWOOD LN
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City | OLD LYME
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State | CT
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Zip | 06371-1867
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Country | US
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Telephone | 860-460-7051
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SWANSWOOD LN
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City | OLD LYME
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State | CT
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Zip | 06371-1867
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Country | US
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Telephone | 860-460-7051
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. JOANN FLYNN
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Credential | LPC
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Telephone | 860-460-7051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 003233
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License Number State | CT
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