Provider Demographics
NPI:1235018318
Name:FLYNN, JESSE ALEXANDER (CADC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ALEXANDER
Last Name:FLYNN
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1704
Mailing Address - Country:US
Mailing Address - Phone:207-774-7111
Mailing Address - Fax:207-239-0326
Practice Address - Street 1:400 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1704
Practice Address - Country:US
Practice Address - Phone:207-774-7111
Practice Address - Fax:207-775-1985
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC9149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)