Provider Demographics
NPI:1003357914
Name:BIRCH PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:BIRCH PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-456-0339
Mailing Address - Street 1:6 FAIRVIEW DR APT 1
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7665
Mailing Address - Country:US
Mailing Address - Phone:203-456-0339
Mailing Address - Fax:
Practice Address - Street 1:175 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3448
Practice Address - Country:US
Practice Address - Phone:203-456-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty