1285865717 NPI number — MS. PATRICIA LAMB FLYNN MSW, LCSW

Table of content: MS. PATRICIA LAMB FLYNN MSW, LCSW (NPI 1285865717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285865717 NPI number — MS. PATRICIA LAMB FLYNN MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN
Provider First Name:
PATRICIA
Provider Middle Name:
LAMB
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUARINO
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
LAMB
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285865717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 20008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97294-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-261-2443
Provider Business Mailing Address Fax Number:
503-254-7948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8840 NE SKIDMORE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97294-0008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-254-7371
Provider Business Practice Location Address Fax Number:
503-254-7948
Provider Enumeration Date:
07/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  L2123 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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