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General NPI Number Information
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NPI Number | 1457874968
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Entity Type | Individual
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Provider Name | KATHLEEN ANN FLYNN LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 2501 W LEHIGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19132-3207
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Country | US
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Telephone | 215-227-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 131 LISMORE AVE
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City | GLENSIDE
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State | PA
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Zip | 19038-4010
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Country | US
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Telephone | 203-947-4090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9319
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW019749
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License Number State | PA
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