Basic Information
| Provider Information | |||||||||
| NPI: | 1447309158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91 WOODS BROOKE LANE | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149625593 | ||||||||
| FaxNumber: | 9149625599 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 N CENTRAL AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105301903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149625593 | ||||||||
| FaxNumber: | 9149625599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 012078-1 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 200681 | 01 | NY | HEALTHNET | OTHER |