1740582196 NPI number — MR. EDWARD T FLYNN M.ED., LMHC

Table of content: MR. EDWARD T FLYNN M.ED., LMHC (NPI 1740582196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740582196 NPI number — MR. EDWARD T FLYNN M.ED., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN
Provider First Name:
EDWARD
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLYNN
Provider Other First Name:
EDWARD
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740582196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 G3 CHESTNUT STREET
Provider Second Line Business Mailing Address:
UNIT 3
Provider Business Mailing Address City Name:
FOXBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-842-0612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 G3 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
FOXBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-842-0612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2010

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: 101YM0800X , with the licence number:  9568 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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