Basic Information
| Provider Information | |||||||||
| NPI: | 1508382581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | SHEENA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-R | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FLYNN | ||||||||
| OtherFirstName: | SHEENA | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW-R | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 859 68TH STREET | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173616055 | ||||||||
| FaxNumber: | 7186806889 | ||||||||
| Practice Location | |||||||||
| Address1: | PARK SLOPE CENTER FOR MENTAL HEALTH 348 13TH STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | PARK SLOPE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112151122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187882461 | ||||||||
| FaxNumber: | 7187888274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 08/21/2017 | ||||||||
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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 | 1041C0700X | 069468 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.