MEDICARE: AMY REBECCA FLYNN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PCO13404	PA

General Provider Information

NPI Number	:	1942879937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY REBECCA FLYNN LPC

Provider Business Mailing Address
First Line	:	1110 GROMWELL LN
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-2074
Country	:	US
Telephone Number	:	609-980-8236
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 W CHESTNUT ST APT 5
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-4669
Country	:	US
Telephone Number	:	724-350-6799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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