Provider Demographics
NPI:1558491787
Name:FLYNN, JENNIFER ANNE (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GLENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1505
Mailing Address - Country:US
Mailing Address - Phone:631-285-7244
Mailing Address - Fax:631-285-7299
Practice Address - Street 1:112 GLENWOOD LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1505
Practice Address - Country:US
Practice Address - Phone:631-285-7244
Practice Address - Fax:631-285-7299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist