Provider Demographics
NPI:1003040007
Name:KENNELLY, LYNN MARIE
Entity Type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:MARIE
Last Name:KENNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:SPIEZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:350 N SIXTH AVENUE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-4065
Practice Address - Country:US
Practice Address - Phone:717-274-9686
Practice Address - Fax:717-274-9549
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst