Doctor Name: | JACQUELINE FLYNN |
NPI Number: | 1073924700 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MH13594 |
Business Practice Address: | 846 North Cocoa Blvd Suite A Cocoa, FL - 329223623 |
Business Phone Number: | 3215442743 |
Business Fax Number: | |
Mailing Address: | 5235 Devon St, COCOA |
State: | FL |
Postal Code: | 329272929 |
Phone Number: | 3215442743 |
Fax Number: | |
NPI Enumeration Date: | 05/15/2014 |
NPI Last Update Date: | 03/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | MH13594 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |