Basic Information
| Provider Information | |||||||||
| NPI: | 1134605306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | RINALDI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19676 STOUGHTON DR | ||||||||
| Address2: | |||||||||
| City: | STRONGSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441495656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044653515 | ||||||||
| FaxNumber: | 2167393639 | ||||||||
| Practice Location | |||||||||
| Address1: | 3518 W 25TH ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441091951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167412241 | ||||||||
| FaxNumber: | 2167393639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2018 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E.2202814 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | C.1801210-TRNE | 01 | OH | CHANGE QMHS TO CT STATUS | OTHER |